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Schiavone, V.; Capolupo, G.T.; Mascianà, G.; Carannante, F.; Costa, G.; Miacci, V.; Caricato, M. Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions. Encyclopedia. Available online: https://encyclopedia.pub/entry/59140 (accessed on 10 December 2025).
Schiavone V, Capolupo GT, Mascianà G, Carannante F, Costa G, Miacci V, et al. Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions. Encyclopedia. Available at: https://encyclopedia.pub/entry/59140. Accessed December 10, 2025.
Schiavone, Vincenzo, Gabriella Teresa Capolupo, Gianluca Mascianà, Filippo Carannante, Gianluca Costa, Valentina Miacci, Marco Caricato. "Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions" Encyclopedia, https://encyclopedia.pub/entry/59140 (accessed December 10, 2025).
Schiavone, V., Capolupo, G.T., Mascianà, G., Carannante, F., Costa, G., Miacci, V., & Caricato, M. (2025, October 15). Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions. In Encyclopedia. https://encyclopedia.pub/entry/59140
Schiavone, Vincenzo, et al. "Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions." Encyclopedia. Web. 15 October, 2025.
Peer Reviewed
Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions
This is a peer-reviewed entry published in Encyclopedia Journal, full entry can be found at 10.3390/encyclopedia5040165

Rectal cancer has become a significant health concern in current years, but there are very effective current neo-adjuvant treatment modalities which can result in the complete disappearance of the disease without surgery, which is often associated with severe post-surgical sequelae. Therefore, a significant effort has been made to identify the subset of patients who can avoid surgery and to investigate the long-term oncologic and functional results associated with the Non-Operative Management of such a disease.

rectal cancer non-operative management total neo-adjuvant treatment and LARS
Rectal cancer remains a major global health concern, with new cases increasing annually [1]. The standard treatment for locally advanced disease has traditionally included neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Although oncologically effective, surgery is associated with considerable morbidities, including bowel, urinary, and sexual dysfunction [2][3].
The concept of Non-Operative Management (NOM), also known as the “Watch-and-Wait” (WW) strategy, has emerged as an alternative for patients achieving a clinical complete response (cCR) after neoadjuvant therapy [4][5]. Early data from the International Watch & Wait Database (IWWD) demonstrated promising long-term oncologic outcomes [6][7]. More recent evidence, including updated National Comprehensive Cancer Network (NCCN) and European Society For Medical Oncology (ESMO) guidelines, supports NOM in carefully selected patients, provided rigorous surveillance protocols are followed [8][9].
Advances in Total Neoadjuvant Therapy (TNT) have increased cCR rates, expanding the pool of patients eligible for organ preservation [10][11]. Novel immunotherapy approaches, particularly in mismatch repair-deficient (dMMR) rectal cancers, have demonstrated unprecedented response rates, raising the possibility of NOM as a curative option without radiation or surgery [12][13].
Given these developments, we present a narrative review focusing on NOM protocols, oncologic and functional outcomes, patient selection, and long-term feasibility.

References

  1. WHO. Globocan Data. Available online: https://gco.iarc.who.int/today/en/dataviz/pie?mode=cancer&types=0&sexes=0&populations=900 (accessed on 26 April 2025).
  2. Lelong, B.; de Chaisemartin, C.; Meillat, H.; Cournier, S.; Boher, J.M.; Genre, D.; Karoui, M.; Tuech, J.J.; Delpero, J.R.; The French Research Group of Rectal Cancer Surgery (GRECCAR). A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): Rationale and design. BMC Cancer 2017, 17, 253.
  3. Carannante, F.; Piozzi, G.N.; Miacci, V.; Bianco, G.; Melone, G.; Schiavone, V.; Costa, G.; Caricato, M.; Khan, J.S.; Capolupo, G.T. Quadruple Assessment of Colorectal Anastomosis after Laparoscopic Rectal Resection. J. Clin. Med. 2024, 13, 5092.
  4. van der Valk, M.J.M.; Hilling, D.E.; Bastiaannet, E.; Kranenbarg, E.M.-K.; Beets, G.L.; Figueiredo, N.L.; Habr-Gama, A.; Perez, R.O.; Renehan, A.G.; van de Velde, C.J.H.; et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in IWWD. Lancet 2018, 391, 2537–2545.
  5. Dossa, F.; Chesney, T.R.; Acuna, S.A.; Baxter, N.N. A watch-and-wait approach for locally advanced rectal cancer after clinical complete response. Lancet Gastroenterol. Hepatol. 2017, 2, 501–513.
  6. Fernandez, L.M.; Julião, G.P.S.; Figueiredo, N.L.; Beets, G.L.; van der Valk, M.J.M.; Bahadoer, R.R.; Hilling, D.E.; Kranenbarg, E.M.-K.; Roodvoets, A.G.H.; Renehan, A.G.; et al. Conditional survival and local regrowth in rectal cancer managed by WW. Ann Surg. 2023, 278, e66–e74.
  7. Smith, J.J.; Strombom, P.; Chow, O.S.; Roxburgh, C.S.; Lynn, P.; Eaton, A.; Widmar, M.; Ganesh, K.; Yaeger, R.; Cercek, A.; et al. Assessment of a watch-and-wait strategy for rectal cancer. JAMA Oncol. 2019, 5, e185896.
  8. National Comprehensive Cancer Network (NCCN). NCCN Guidelines: Rectal Cancer, Version 2025. Available online: https://www.nccn.org/guidelines/guidelines-detail?id=1461 (accessed on 26 April 2025).
  9. Glynne-Jones, R.; Wyrwicz, L.; Tiret, E.; Brown, G.; Rödel, C.; Cervantes, A.; Arnold, D. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2017, 28, 22–40.
  10. Kasi, A.; Abbasi, S.; Handa, S.; Al-Rajabi, R.; Saeed, A.; Baranda, J.; Sun, W. Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Rectal Cancer. JAMA Netw. Open. 2020, 3, e2030097.
  11. Conroy, T.; Bosset, J.F.; Etienne, P.L.; Rio, E.; François, É.; Mesgouez-Nebout, N.; Vendrely, V.; Artignan, X.; Bouché, O.; Gargot, D.; et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): A multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021, 22, 702–715.
  12. Cercek, A.; Lumish, M.; Sinopoli, J.; Weiss, J.; Shia, J.; Lamendola-Essel, M.; El Dika, I.H.; Segal, N.; Shcherba, M.; Sugarman, R.; et al. PD-1 blockade in mismatch repair–deficient rectal cancer. N. Engl. J. Med. 2022, 386, 2363–2376.
  13. Lin, Z.Y.; Zhang, P.; Chi, P.; Xiao, Y.; Xu, X.M.; Zhang, A.M.; Qiu, X.F.; Wu, J.X.; Yuan, Y.; Wang, Z.N.; et al. Neoadjuvant short-course radiotherapy followed by camrelizumab and chemotherapy (UNION trial). Ann. Oncol. 2024, 35, 882–891.
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Subjects: Gastroenterology & Hepatology
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register : Vincenzo Schiavone , Gabriella Teresa Capolupo , Gianluca Mascianà , Filippo Carannante , Gianluca Costa , Valentina Miacci , Marco Caricato
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Online Date: 15 Oct 2025
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