Annals of Coloproctology

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Inflammatory/benign bowel disease

Clinical outcomes and optimal indications for nonoperative management of acute appendicitis in adult patients: a comprehensive literature review: Hyun Gu Lee, In Ja Park; Ann Coloproctol. 2025;41(2):107-118. Published online April 16, 2025; DOI: https://doi.org/10.3393/ac.2023.00192.0027

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5 Citations

Appendectomy as the standard treatment for acute appendicitis has been challenged by accumulating evidence supporting nonoperative management with antibiotics as a potential primary treatment. This review aimed to summarize the clinical outcomes and the optimal indications for nonoperative management of acute appendicitis in adults. Current evidence suggests that uncomplicated and complicated appendicitis have different pathophysiologies and should be treated differently. Nonoperative management for uncomplicated appendicitis was not inferior to appendectomy in terms of complications and length of stay, with less than a 30% failure rate at 1 year. The risk of perforation and postoperative complications did not increase even if nonoperative management failed. Complicated appendicitis with localized abscess or phlegmon could also be treated conservatively, with a success rate of more than 80%. An interval appendectomy following successful nonoperative management is recommended only for patients over the age of 40 years to exclude appendiceal malignancy. The presence of appendicoliths increased the risk of treatment failure and complications; thus, it may be an indication for appendectomy. Nonoperative management is a safe and feasible option for both uncomplicated and complicated appendicitis. Patients should be informed that nonoperative management may be a safe alternative to surgery, with the possibility of treatment failure.

Citations

Citations to this article as recorded by

Three-year follow-up of antibiotics versus surgery for acute appendicitis
S Bose, HJ Wong, C Skouras, Y Maeda
The Annals of The Royal College of Surgeons of England.2026;[Epub] CrossRef
Non-operative Management of Uncomplicated Appendicitis: A Review of Indications, Safety, and Clinical Algorithms
Mohamed Baana, Meghana Singh, Moses Banfa, Laraib Tariq, Tomas Antoni Barbaroux, Faryal Ali, Ahmad Mahmood, Juan J Prieto, Shaikha Alhajeri, Joy W Youssef, Sudharsan Ramapriya
Cureus.2026;[Epub] CrossRef
Are the long-term oncologic outcomes different between appendiceal cancer and right-sided colon cancer? An exact matching analysis of a 10-year institutional cohort
Gunwoo Lee, Eun Jung Park, Soo Young Oh, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Annals of Surgical Treatment and Research.2026; 110(4): 246. CrossRef
Acute appendicitis in geriatric population: a clinical and prognostic comparison of surgical intervention and conservative management
Fırat Aslan, Serhat Binici, Burhan Beger, Orhan Beger, Halil Alper Bozkurt, Muzaffer Onder Oner, Iklil Eryılmaz, Mehmet Cetin Kotan, Mehmet Eryılmaz
BMC Geriatrics.2026;[Epub] CrossRef
Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions
Ju Tian
World Journal of Clinical Cases.2025;[Epub] CrossRef

Colorectal cancer

Survival outcomes of salvage surgery in the watch-and-wait approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis: Wenjie Lin, Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Emile Kwong-Wei Tan; Ann Coloproctol. 2023;39(6):447-456. Published online December 28, 2023; DOI: https://doi.org/10.3393/ac.2022.01221.0174

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218 Download
9 Web of Science
12 Citations

Abstract PDF Supplementary Material

Purpose
This systematic review and meta-analysis compared the outcomes of the watch-and-wait (WW) approach versus radical surgery (RS) in rectal cancers with clinical complete response (cCR) after neoadjuvant chemoradiotherapy.
Methods
This study followed the PRISMA guidelines. Major databases were searched to identify relevant articles. WW and RS were compared through meta-analyses of pooled proportions. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis rates. Pooled salvage surgery rates and outcomes were also collected. The Newcastle-Ottawa scale was employed to assess the risk of bias.
Results
Eleven studies including 1,112 rectal cancer patients showing cCR after neoadjuvant chemoradiation were included. Of these patients, 378 were treated nonoperatively with WW, 663 underwent RS, and 71 underwent local excision. The 2-year OS (risk ratio [RR], 0.95; P = 0.94), 5-year OS (RR, 2.59; P = 0.25), and distant metastasis rates (RR, 1.05; P = 0.80) showed no significant differences between WW and RS. Local recurrence was more frequent in the WW group (RR, 6.93; P < 0.001), and 78.4% of patients later underwent salvage surgery (R0 resection rate, 97.5%). The 2-year DFS (RR, 1.58; P = 0.05) and 5-year DFS (RR, 2.07; P = 0.02) were higher among RS cases. However, after adjustment for R0 salvage surgery, DFS showed no significant between-group difference (RR, 0.82; P = 0.41).
Conclusion
Local recurrence rates are higher for WW than RS, but complete salvage surgery is often possible with similar long-term outcomes. WW is a viable strategy for rectal cancer with cCR after neoadjuvant chemoradiation, but further research is required to improve patient selection.

Citations

Citations to this article as recorded by

Current and Future Strategies versus Tradeoffs in Maximizing the Treatment Response in Rectal Cancer: A Focus on MSI-H Disease
FNU Anamika, Nicholas Hornstein, Mirac Ajredini, John R. T. Monson
Clinics in Colon and Rectal Surgery.2026;[Epub] CrossRef
Watch‐and‐Wait Approach Following Neoadjuvant Chemo‐Radiotherapy for Locally Advanced Rectal Cancer: A Retrospective Single‐Center Cohort Study
Georgi Kalev, Sylvia Buettner, Tianzuo Zhan, Ralf‐Dieter Hofheinz, Judit Boda‐Heggemann, Christoph Reissfelder, Steffen Seyfried, Georgi Vassilev, Julia Hardt
Journal of Surgical Oncology.2025; 131(4): 658. CrossRef
Phase 2, Multicenter, Open-label, Nonrandomized Study of Neoadjuvant Chemotherapy Liposomal Irinotecan With 5-Fluorouracil, Leucovorin, and Oxaliplatin, Followed by Chemoradiotherapy in Patients With Rectal Cancer in a Watch-and-Wait Program
César Muñoz, María-C. Riesco Martinez, Lisardo Ugidos, Pilar García-Alfonso, Rafael Alvarez-Gallego, Paloma Peinado, Carmen Toledano, Luka Mihic-Góngora, Justo Gabriel Ortega Anselmi, Enrique Sanz Garcia, Emilio Vicente, Yolanda Quijano, Hipólito J. Durán
American Journal of Clinical Oncology.2025; 48(3): 142. CrossRef
Therapeutic Management of Locally Advanced Rectal Cancer: Existing and Prospective Approaches
Horia-Dan Lișcu, Nicolae Verga, Dimitrie-Ionuț Atasiei, Andreea-Teodora Ilie, Maria Vrabie, Laura Roșu, Alexandra Poștaru, Stefania Glăvan, Adriana Lucaș, Maria Dinulescu, Andreea Delea, Andreea-Iuliana Ionescu
Journal of Clinical Medicine.2025; 14(3): 912. CrossRef
A management of patients achieving clinical complete response after neoadjuvant therapy and perspectives: on locally advanced rectal cancer
Yu-Xin Liu, Xin-Rong Yang, Lan-Qing Peng, Zhuo-Hong Li
Frontiers in Oncology.2025;[Epub] CrossRef
ACCORD study: a national multi‐centre study of the watch and wait approach in patients with rectal cancer in Aotearoa New Zealand

ANZ Journal of Surgery.2025; 95(3): 440. CrossRef
Watch and wait in early onset rectal cancer patients: A review of the literature
Melissa K Drezdzon, Carrie Y Peterson
Seminars in Colon and Rectal Surgery.2025; : 101117. CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. CrossRef
Non-Operative Management (NOM) in Rectal Cancer: Current Evidence and Future Directions
Vincenzo Schiavone, Gabriella Teresa Capolupo, Gianluca Mascianà, Filippo Carannante, Gianluca Costa, Valentina Miacci, Marco Caricato
Encyclopedia.2025; 5(4): 165. CrossRef
Advancing Personalized Medicine in the Treatment of Locally Advanced Rectal Cancer
Francesco Giulio Sullo, Alessandro Passardi, Chiara Gallio, Chiara Molinari, Giorgia Marisi, Eleonora Pozzi, Leonardo Solaini, Alessandro Bittoni
Journal of Clinical Medicine.2024; 13(9): 2562. CrossRef
Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
Youn Young Park, Nam Kyu Kim
Annals of Gastroenterological Surgery.2024; 8(5): 761. CrossRef
Combined Transanal and Laparoscopic Approach for Full-Thickness Local Excision of Locally Advanced Rectal Cancer Following Near-Complete Response after Chemotherapy
Joshua S. H. Lim, Si-Lin Koo, Iain Beehuat Tan, Isaac Seow-En
World Journal of Colorectal Surgery.2024; 13(3): 95. CrossRef

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