Debate watch party.

The debate over rectal preservation among patients with good clinical responses to chemoradiation promises to outlast most presidential hopefuls. This commentary by a Toronto group on the recent MSK series harshly points out it “adds only marginally to our existing knowledge” as it does little to inform true recurrence rates among the hypothetical ideal candidate for organ preservation. This is due, of course, to its lack of randomization with those in the organ preservation cohort having worse tumor locations and/or worse health making observation a more attractive off-trial option. Hmm these inherent bias critiques sound familiar. Oh, that’s right, we read them in a commentary critiquing this same Toronto group’s recent non-randomized data on complete responders. Authors of the MSK series retort with the classic: sure, it’s not randomized, but it adds more than marginal knowledge about outcomes with an organ preservation approach among the patients who need it most. Especially when trials randomizing to +/- a major surgery are notoriously unpopular. TBL: Pop some popcorn because this debate has no end in sight. | Dossa & Smith, JAMA Oncol 2019