Colorectal cancer: more rectal patients keep their bowel and skip surgery

If you or someone you love ever faces rectal cancer, here is welcome news. Surgery and a colostomy bag are no longer the only road for everyone. In a large US study of colorectal cancer care, about 1 in 3 patients in 2023 skipped surgery after their treatment worked very well, and were watched closely instead.

This approach is called “watch and wait.” It is becoming a regular part of how rectal cancer is treated in this country, and it is growing fast.

How the study worked

Researchers used the National Cancer Database to look back at a large group of people treated at US hospitals accredited by the Commission on Cancer. All were diagnosed with stage II to III rectal cancer between 2006 and 2023, and all got chemotherapy and radiation first. The results were published Oct. 1, 2026, in JAMA Network Open. The database does not label watch and wait directly, so the team estimated it from the people who skipped surgery beyond the usual rate, and it does not track regrowth or survival.

What they found

The change has been big. In 2015, watch and wait was used for about 2 in 100 patients (2.30%). By 2023, it was about 1 in 3 (32.94%).

The pace also picked up. Through 2014, the share of people skipping surgery held steady. From 2015 to 2018, it grew by about 10% each year (9.83%). From 2019 to 2023, it grew by about 22% each year (21.71%).

Every age group saw the rise. Adults 80 and older moved first, with a clear increase beyond their usual rate by 2015. Adults under 50 followed a few years later, by 2019.

The researchers say the jump after 2019 fits with growing evidence and updated guidelines that support watch and wait. In other words, doctors are putting new knowledge to work.

What is watch and wait?

For stage II to III rectal cancer, standard care has long been chemotherapy and radiation, followed by surgery to remove the rectum. That surgery can mean a permanent colostomy bag.

But in some people, the tumor disappears completely with treatment. In those cases, watch and wait skips the surgery. You keep your rectum, and your care team checks in on a strict schedule, with exams, endoscopy and imaging. Avoiding surgery can help preserve bowel function and quality of life.

The checks matter because in some people the tumor grows back. With regular follow-up, any regrowth is caught early and treated.

If you or someone close to you has rectal cancer that responded very well to treatment, these are good questions for the care team:

• Is watch and wait an option for me?
• What checks would I need, and how often?
• What is the chance of regrowth, and what happens if it comes back?

What you can do today

The best way to catch colorectal cancer early is screening at the recommended age. Open your patient portal or call your doctor’s office and ask when your last screening was and when the next one is due. If you are up to date, you are set. If not, ask to schedule it while you have the phone in your hand.