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Abstract: The International Watch and Wait Database (IWWD) for rectal cancer, an update

M. Van der Valk, On behalf of the IWWD Consortium.

LUMC, Surgery, Leiden, Netherlands

Background: In 2014 the International Watch-and-Wait Database (IWWD) for rectal cancer was established under the umbrella of EURECCA and the Champalimaud Foundation. The main goal of this database is to collect all available data to expand knowledge on the benefits, risks and oncological safety of organ preserving strategies in rectal cancer [Beets, ESJO 2015 41(12): 1562−4]. In April 2015 the database was opened for retrospective and prospective data registration.

Methods: An international multicentre observational study. Data was collected by participating centres and stored in a highly secured NEN7510 certified and encrypted research data server. Each centre always retains full ownership of their data.

Table 1. Data for 679 patients with clinical complete response

Gender Male 449 (66%)
  Female 230 (34%)
Age Mean 63.6 years
BMI Mean  6.7 kg/m2
Imaging Endo/rectoscopy  598 (87%)
  MRI 434 (64%)
  ERUS 42 (6%)
  CT-pelvis 172 (25%)
T stage baseline cT1 13 (2%)
  cT2 146 (28%)
  cT3 335 (64%)
  cT4 27 (5%)
N stage baseline cN0  208 (40%)
  cN1 185 (35%)
  cN2 132 (25%)
M stage baseline M0  635 (99%)
  M+ 8 (1%)

Results: In August 2016 the database included 775 patients from 11 countries and 35 participating institutes. 90% of all patients were included because of a clinical complete response (n = 679). All other reasons for a watch-and-wait regimen, such as a near-complete response, were excluded for the present analyses. The year of decision for a watch-and-wait regimen ranged between 1991 and 2016. As shown in Table 1, imaging modalities used to assess response after induction therapy were variable, most frequently used modalities were endoscopy and MRI. Induction treatment consisted of chemo-radiotherapy in 90% of all cases. Median follow-up time is 2.6 years (range 0−24 years). Local regrowth occurred in 25% (n = 167) of all patients, of which 64% within the first year of follow up and 84% in the first 2 years. A local regrowth was located endoluminal in 96% (n = 161) and in the loco-regional lymph nodes in 4% (n = 7). Distant metastasis occurred in 7% (n = 49), of which 65% in the first two years of follow-up. The overall 3 year-survival of all patients was 91% and for patients with a local regrowth this was 87%.

Conclusions: This is the largest retrospective series of patients with rectal cancer in which surgery was omitted after induction therapy. These data illustrate differences in induction therapy as well as baseline or followup imaging strategies and provide some crude outcome data. Further prospective data collection on the Watch-and-Wait strategy for rectal cancer is needed to increase our knowledge on oncological safety of omitting surgery. This may contribute to international consensus on staging, treatment and surveillance guidelines in rectal cancer care.

No conflicts of interest


European Journal of Cancer Volume 72, Supplement 1, Pages S55–S56

© 2017 Elsevier Ltd. All rights reserved.

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