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BACKGROUND:

In elderly and comorbid patients with rectal cancer, radical surgery is associated with significant perioperative mortality. Data suggest that a watch-and-wait approach where a complete clinical response is obtained after neoadjuvant chemoradiotherapy might be oncologically safe.

OBJECTIVE:

This study aimed to determine whether patient age and comorbidity should influence surgeon and patient decision making where a complete clinical response is obtained.

DESIGN:

Decision-analytic modeling consisting of a decision tree and Markov chain simulation was used. Modeled outcome parameters were elicited both from comprehensive literature review and from a national patient outcomes database.

SETTINGS:

Outcomes for 3 patient cohorts treated with neoadjuvant therapy were modeled after either surgery or watch and wait.

PATIENTS:

Patients included 60-year-old and 80-year-old men with mild …