In patients with rectal cancer who achieve clinical complete response after neoadjuvant chemoradiotherapy, watch-and-wait (W&W) is a novel management strategy with potential to avoid major surgery but this is not yet routine practice. Observational studies have shown that watch-and-wait strategy is safe and have similar oncological outcomes compared with surgery in these group of patients (1). Evidence of cost-effectiveness of watch-and-wait strategy will better inform policy decision making on whether to endorse and implement this strategy of organ preservation. Hence, we undertook a systematic review of economic evaluation in this question.