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Background <p>The purpose of this study was to retrospectively compare the prognostic outcomes of patients with colorectal cancer (CRC) who achieved a clinical complete response (CCR) after neoadjuvant immunotherapy (NI) and those who achieved a CCR after surgery. A literature review of publications was conducted in the PubMed database.</p> Materials and methods <p>This study included 70 patients who were diagnosed with mismatch repair deficiency/microsatellite instability high (dMMR/MSI-H) colorectal cancer and who were treated with NI between 2018 and 2024. CCR patients were grouped into the “watch and wait” (W&amp;W) method group or the radical surgery group. Afterwards, the oncological and clinical outcomes of patients who achieved a clinical complete response (CCR) were compared to those of patients who were classified as tumour free. We also conducted a literature review of publications in the PubMed database of clinical studies that compared clinical outcomes between W&amp;W and surgery for CCR dMMR/MSI-H patients.</p> Results <p>Among the 70 NI-treated dMMR/MSI-H CRC patients, 44 (62.86%) achieved a CCR. Of these, 25 patients were managed with a watch-and-wait (W&amp;W) strategy, while 19 underwent curative-intent surgery. In the surgery group, 16 patients (84.21%) achieved a pathological complete response (pCR). During follow-up, 2 patients (10.53%) in the surgery group developed recurrence, and both subsequently died, while the remaining 17 patients were alive at the last follow-up. No statistically significant differences were observed between the W&amp;W and surgery groups in terms of recurrence or survival outcomes. A literature review including nine studies further demonstrated comparable oncological outcomes between W&amp;W and surgical management in patients who achieved a CCR.</p> Conclusion <p>Patients in the W&amp;W group presented similar oncological outcomes to those who underwent surgery. Surgery may not be necessary for patients with dMMR/MSI-H colorectal cancer who achieve a clinical complete response after neoadjuvant immunotherapy. However, large sample sizes and multicentre investigations are needed to validate these findings.</p>

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Is surgery necessary for mismatch repair-deficient/microsatellite instability-high colorectal cancer patients with a clinical complete response after neoadjuvant immunotherapy? A retrospective cohort study with literature context

  • 期刊论文

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  • 发表日期：

    2026年5月2日

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  • Hongqun Zuo,
  • Jian Huang,
  • Shengquan Peng,
  • Jie Wei,
  • Yinxiang Luo,
  • Shimeng Qin,
  • Xiaojun Zou,
  • Ju Rong,
  • Yuan Lin,
  • Hao Lai,
  • Xianwei Mo

摘要

Background

The purpose of this study was to retrospectively compare the prognostic outcomes of patients with colorectal cancer (CRC) who achieved a clinical complete response (CCR) after neoadjuvant immunotherapy (NI) and those who achieved a CCR after surgery. A literature review of publications was conducted in the PubMed database.

Materials and methods

This study included 70 patients who were diagnosed with mismatch repair deficiency/microsatellite instability high (dMMR/MSI-H) colorectal cancer and who were treated with NI between 2018 and 2024. CCR patients were grouped into the “watch and wait” (W&W) method group or the radical surgery group. Afterwards, the oncological and clinical outcomes of patients who achieved a clinical complete response (CCR) were compared to those of patients who were classified as tumour free. We also conducted a literature review of publications in the PubMed database of clinical studies that compared clinical outcomes between W&W and surgery for CCR dMMR/MSI-H patients.

Results

Among the 70 NI-treated dMMR/MSI-H CRC patients, 44 (62.86%) achieved a CCR. Of these, 25 patients were managed with a watch-and-wait (W&W) strategy, while 19 underwent curative-intent surgery. In the surgery group, 16 patients (84.21%) achieved a pathological complete response (pCR). During follow-up, 2 patients (10.53%) in the surgery group developed recurrence, and both subsequently died, while the remaining 17 patients were alive at the last follow-up. No statistically significant differences were observed between the W&W and surgery groups in terms of recurrence or survival outcomes. A literature review including nine studies further demonstrated comparable oncological outcomes between W&W and surgical management in patients who achieved a CCR.

Conclusion

Patients in the W&W group presented similar oncological outcomes to those who underwent surgery. Surgery may not be necessary for patients with dMMR/MSI-H colorectal cancer who achieve a clinical complete response after neoadjuvant immunotherapy. However, large sample sizes and multicentre investigations are needed to validate these findings.