Background: Deficient mismatch repair rectal cancer represents approximately 10% of rectal malignancies and demonstrates exceptional responsiveness to immune checkpoint inhibitors, achieving unprecedented complete response rates approaching 100%. This creates a novel clinical dilemma: should patients achieving complete response undergo standard surgical resection or pursue organ preservation through watch-and-wait management? Methods: We conducted a comprehensive literature review of clinical trials and retrospective studies published through 2025, focusing on response assessment strategies, decision-making frameworks, oncological outcomes, and quality of life assessments. Results: Landmark studies demonstrated remarkable efficacy with dostarlimab achieving 100% clinical complete response, while surgical cohorts achieved 68–92% pathological complete response rates. Response assessment challenges included pseudoprogression and pseudoresidue phenomena that complicated conventional imaging interpretation and required specialised multimodal evaluation protocols. Comparative analyses suggest equivalent oncological outcomes between surgical and non-surgical approaches in complete responders, achieving 100% disease-free survival at 2–3 years across multiple studies. The watch-and-wait approach offered significant advantages by preserving organ integrity and avoiding surgical morbidity, including permanent colostomy (15.4%) and perioperative complications (19.3%). Conversely, surgical management provided distinct benefits through definitive tissue confirmation and anxiety relief from intensive surveillance requirements and potential recurrence concerns. Conclusions: The surgery versus watch-and-wait dilemma represents a choice between equally effective oncological approaches with different quality of life implications. Evidence supports individualised decision-making weighing functional preservation benefits against patient preferences and institutional capabilities in this evolving therapeutic landscape.
**背景**：错配修复缺陷型直肠癌约占直肠恶性肿瘤的10%，对免疫检查点抑制剂表现出卓越的反应性，实现了接近100%的史无前例的完全缓解率。这引发了一个新的临床困境：达到完全缓解的患者是应该接受标准的手术切除，还是通过"观察等待"管理以实现器官保留？ **方法**：我们对截至2025年发表的临床试验和回顾性研究进行了全面的文献综述，重点关注疗效评估策略、决策框架、肿瘤学结局以及生活质量评估。 **结果**：标志性研究表明，多塔利单抗实现了100%的临床完全缓解，疗效显著；而手术队列的病理完全缓解率为68–92%。疗效评估面临的挑战包括假性进展和假性残留现象，这些现象使传统的影像学解读复杂化，需要专门的多模态评估方案。比较分析表明，在达到完全缓解的患者中，手术与非手术方法具有同等的肿瘤学结局，多项研究显示2-3年无病生存率均达到100%。"观察等待"方法通过保留器官完整性和避免手术相关并发症（包括永久性结肠造口[15.4%]和围手术期并发症[19.3%]）提供了显著优势。相反，手术治疗通过明确的组织学确认、减轻因密集监测要求和潜在复发担忧带来的焦虑，提供了独特的益处。 **结论**：手术与"观察等待"之间的困境，代表了在两种肿瘤学疗效相当但生活质量影响不同的方法之间做出选择。证据支持在这一不断发展的治疗格局中，进行个体化决策，权衡功能保留的益处与患者偏好及机构能力。
Immunotherapy-Induced Complete Response in dMMR Rectal Cancer—A Surgical Dilemma?
肿瘤(癌症)患者之家