Smith JJ, et al. - A watch-and-wait (WW) strategy is sometimes taken to spare patients with rectal cancer unnecessary resection, so researchers conducted this retrospective case series analysis to investigate its outcomes among patients with rectal cancer who had a clinical complete response to neoadjuvant therapy. With a watchful waiting strategy, excellent rectal preservation (82%) and pelvic tumor control (91%) were observed among 113 of these patients, but with worse survival compared to 136 patients undergoing total mesorectal excision who had a pathologic complete response. In addition, they noted a higher incidence of distant progression among patients managed by the watch-and-wait strategy who developed local regrowth vs those who did not develop local regrowth. Findings thus suggest that for most patients, a watch-and-wait strategy may be safe, but there needs to be better risk stratification for a more precise way to identify those at high risk of local regrowth and who are not optimal candidates.