To the Editor We read with interest the report by Ellis et al1 suggesting a word of caution regarding no surgery following neoadjuvant chemoradiation (CRT) for rectal cancer. The authors warn readers about the risks of inferior survival rates in patients with rectal cancer who never underwent surgical resection, suggesting a link between these unfavorable outcomes and the watch and wait approach. However, the unaware reader may miss the flaws of the study that may lead to an entirely different message.