Purpose: Sir Charles Gairdner Hospital (SCGH) commenced Watch and Wait (W&W) in 2017 for rectal adenocarcinoma using a rigorous surveillance protocol. Our earlier results (2017-2019) have been published. We report updated results and suggest a rationalisation of the protocol. Methodology: A retrospective review of a prospectively maintained database and medical records was performed. All patients from 2017-2023 who were referred for long course chemoradiotherapy (LCCRT) as part of rectal adenocarcinoma treatment with curative intent were included. Results: 142 patients were referred for induction LCCRT for rectal cancer. Consolidation chemotherapy usually followed. Six patients did not complete; 31 had a complete or near complete clinical response and were enrolled in W&W. Six patients declined surgery and were offered W&W. Of the 37 patients in W&W, 5 patients had suspected local regrowth and underwent surgical resection. 2/5 had pCR on histopathology. Regrowth cases were identified within 9 months by flexible sigmoidoscopy and sometimes on imaging (PET or MRI). 95 patients did not have cCR and had surgical resection; of these 20 had pCR. Conclusion: 23% of patients referred for LCCRT at SCGH achieved cCR, and this was sustained in 84%. 16% of W&W patients had suspected local regrowth. Our surveillance protocol detected regrowth early and surgical salvage was always possible. 20% of patients undergoing surgery have pCR despite not having cCR highlights the difficulty in avoiding TME in all patients who have a pCR. We propose a reduction in the length and intensity of our current protocol.