{"entity":{"id":"organ-preservation","kind":"term","name":"Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)","aka":["organ-preservation","organ preservation","organ-sparing","organ sparing","bladder-sparing","bladder preservation","bladder-preserving","larynx preservation","larynx-preserving","sphincter preservation","sphincter-sparing","watch-and-wait","watch and wait","non-operative management","nonoperative management","NOM","rectum preservation","limb preservation","breast preservation","fertility-sparing","nerve-sparing"],"tldr":"Curing a cancer with drugs and radiotherapy so that the organ (rectum, bladder, larynx, limb) does not have to be removed, keeping surgery in reserve for the minority whose cancer regrows.","summary":"Definitive chemoradiation preserves the larynx (VA Larynx trial) and the anus (Nigro); trimodality therapy preserves the bladder in selected muscle-invasive cancer and complete responders to enfortumab vedotin plus pembrolizumab are being spared cystectomy in trials; total neoadjuvant therapy with watch-and-wait for clinical complete responders preserves the rectum in about half of patients (OPRA), and dostarlimab alone cured dMMR rectal cancers without surgery or radiation. Requirements are reliable response assessment (MRI, endoscopy, ctDNA), intensive surveillance and the capacity for timely salvage surgery when regrowth occurs. Patients often accept some extra recurrence risk to keep their organ.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Watchful_waiting","links":[{"label":"Garcia-Aguilar et al., OPRA: organ preservation in rectal adenocarcinoma treated with total neoadjuvant therapy (Journal of Clinical Oncology 2022)","url":"https://doi.org/10.1200/JCO.22.00032"},{"label":"NICE NG151: colorectal cancer, recommendations","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations"},{"label":"Macmillan: chemoradiation for rectal cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/chemoradiation-for-rectal-cancer"}],"tags":[],"related":["total-neoadjuvant-therapy","chemoradiation","salvage-therapy","stoma","de-escalation"],"cancers":["colorectal","urothelial","head-and-neck"],"sections":["radiation","surgery"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-garcia-aguilar-opra-organ-preservation-jco-2022"],"journals":[],"dependsOn":[],"notes":["Rectal cancer (watch and wait): NICE NG151 says to inform people with a complete clinical and radiological response to neoadjuvant treatment who wish to defer surgery that there is a risk of recurrence and that there are no prognostic factors to guide selection for deferral, and that for those who choose to defer, teams should encourage participation in a clinical trial and ensure data is collected via a national registry."],"category":"Treatment jargon"},"route":"/terms/organ-preservation/","neighbours":{"term":[{"id":"active-surveillance-term","kind":"term","name":"Active surveillance and observation","route":"/terms/active-surveillance-term/"},{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"},{"id":"clinical-complete-response","kind":"term","name":"Clinical complete response (cCR)","route":"/terms/clinical-complete-response/"},{"id":"de-escalation","kind":"term","name":"De-escalation, escalation and response-adapted therapy","route":"/terms/de-escalation/"},{"id":"nmibc-vs-mibc","kind":"term","name":"Non-muscle-invasive vs muscle-invasive bladder cancer (NMIBC / MIBC)","route":"/terms/nmibc-vs-mibc/"},{"id":"cystectomy","kind":"term","name":"Radical cystectomy","route":"/terms/cystectomy/"},{"id":"salvage-therapy","kind":"term","name":"Salvage therapy","route":"/terms/salvage-therapy/"},{"id":"stoma","kind":"term","name":"Stoma (colostomy, ileostomy, urostomy)","route":"/terms/stoma/"},{"id":"total-mesorectal-excision","kind":"term","name":"Total mesorectal excision (TME)","route":"/terms/total-mesorectal-excision/"},{"id":"total-neoadjuvant-therapy","kind":"term","name":"Total neoadjuvant therapy (TNT, rectal cancer)","route":"/terms/total-neoadjuvant-therapy/"},{"id":"watch-and-wait-rectal-cancer","kind":"term","name":"Watch and wait after chemoradiotherapy for rectal cancer","route":"/terms/watch-and-wait-rectal-cancer/"}],"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"msi-high-colorectal","kind":"cancer","name":"Mismatch-repair deficient (MSI-high) colorectal cancer","route":"/cancers/msi-high-colorectal/"},{"id":"rectal-cancer","kind":"cancer","name":"Rectal cancer","route":"/cancers/rectal-cancer/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"paper":[{"id":"paper-cercek-nonoperative-management-mismatch-repair-deficient-tumours-nejm-2025","kind":"paper","name":"Nonoperative management of mismatch repair-deficient tumors","route":"/key-papers/paper-cercek-nonoperative-management-mismatch-repair-deficient-tumours-nejm-2025/"},{"id":"paper-habr-gama-nonoperative-stage-0-rectal-ann-surg-2004","kind":"paper","name":"Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results","route":"/key-papers/paper-habr-gama-nonoperative-stage-0-rectal-ann-surg-2004/"},{"id":"paper-garcia-aguilar-opra-organ-preservation-jco-2022","kind":"paper","name":"Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA)","route":"/key-papers/paper-garcia-aguilar-opra-organ-preservation-jco-2022/"},{"id":"paper-sauer-preoperative-chemoradiotherapy-rectal-nejm-2004","kind":"paper","name":"Sauer 2004: chemoradiotherapy before rather than after surgery for rectal cancer (CAO/ARO/AIO-94)","route":"/key-papers/paper-sauer-preoperative-chemoradiotherapy-rectal-nejm-2004/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"}],"idea":[{"id":"idea-crc-organ-preservation-randomised-in-pmmr-rectal","kind":"idea","name":"Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint","route":"/ideas/idea-crc-organ-preservation-randomised-in-pmmr-rectal/"}],"person":[{"id":"angelita-habr-gama","kind":"person","name":"Angelita Habr-Gama","route":"/people/angelita-habr-gama/"}],"trial":[{"id":"opra","kind":"trial","name":"OPRA","route":"/trials/opra/"}]}}