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Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006-2020.
Anthony Loria1, Mohamedtaki A Tejani2, Larissa K Temple1
1Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York.
JAMA Oncology
|November 9, 2023
Summary
Organ preservation in rectal cancer management has increased significantly in the US, particularly with neoadjuvant therapy. This trend aligns with new guidelines, but requires standardized outcome measures for quality care.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- The National Comprehensive Cancer Network (NCCN) now recommends a 'watch and wait' approach for patients achieving a complete clinical response after total neoadjuvant therapy.
- Neoadjuvant therapy has demonstrated high efficacy, making this NCCN recommendation potentially impactful.
- Current trends in organ preservation for rectal cancer in the United States are not well-documented.
Purpose of the Study:
- To analyze trends in organ preservation for patients with rectal adenocarcinoma in the US between 2006 and 2020.
- To understand the implications of increasing neoadjuvant therapy efficacy on treatment strategies and outcomes.
Main Methods:
- A retrospective, observational case series utilizing data from the National Cancer Database (2006-2020).
- Included adult patients (≥18 years) with rectal adenocarcinoma treated with curative intent.
- Primary exposure was the year of treatment; therapies included chemotherapy, radiation, and surgery (proctectomy, transanal local excision, no resection), classified as neoadjuvant or adjuvant.
Main Results:
- The overall proportion of organ preservation increased by 9.8 percentage points (18.4% to 28.2%) from 2006 to 2020 (P < .001).
- Significant increases in organ preservation were observed for stages IIA-IIC (13.0 percentage points) and IIIA-IIIC (12.9 percentage points).
- Conversely, organ preservation declined by 6.1 percentage points for stage I disease (P < .001), and transanal local excisions decreased across all stages.
Conclusions:
- Rectal cancer management is shifting towards non-surgical approaches, particularly for patients historically treated with proctectomy.
- The rise in organ preservation, coupled with a nearly threefold increase in complete pathologic responses (6.5% to 18.8%), supports this trend.
- Urgent development of multidisciplinary core outcome sets and quality indicators is needed to ensure high-quality care and research in organ-preserving rectal cancer treatment.
