 Preoperative chemoradiotherapy followed by a delay to resection can produce pathological complete responses. One review of phase II and III studies identified an overall pCR rate of 13.5, but even higher rates of pCR have been observed with doses of radiotherapy exceeding 45 Gy 12. Certainly patients who proceed to radical surgery after achieving a pCR with chemo radiation do have favorable long-term outcomes13. But do patients whose tumor has already been sterilized by chemo radiotherapy need to proceed with radical surgery? A number of studies have now emerged highlighting the rationale of a wait and see policy for patients who achieve a complete clinical response cCR after chemo radiotherapy. The majority of the clinical data supporting this approach have come from Brazil 14-20. The Brazilian data suggests that observation of such patients yields survival rates similar to those of patients who undergo radical surgery with confirmation of pCR 16. More recent studies from the United Kingdom and the Netherlands appear to support the feasibility of this approach 21, 22. To date there is no published prospectively collected data of a wait-and-see policy from a North American Centre. 