Top line:
Proctectomy and other surgeries are becoming less popular for the treatment of stages II and III. rectal cancer In the US.
methodology:
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The National Comprehensive Cancer Network recommends observation rather than surgery if a patient with rectal cancer has a complete clinical response to neoadjuvant therapy, but patients and healthcare providers It is unclear how often this organ-sparing approach is chosen.
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To find out, researchers looked at 175,545 adults in the National Cancer Database who were treated for rectal adenocarcinoma from 2006 to 2020.
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The research team evaluated changes in the proportion of patients who received chemotherapy or radiation therapy without tumor resection, transanal local excision, or rectal resection.
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The mean age of patients was 63 years, 39.7% were female, 17.4% had stage 1 disease, 24.7% had stage 2A-C disease, and 32.1% had stage 3A-C tumors. The tumor stage was unknown in more than a quarter of the patients.
remove:
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The annual absolute rate of organ preservation increased by more than 50% from 18.4% in 2006 to 28.2% in 2020.
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Within that period, organ preservation rates increased from 19.5% to 32.5% for patients with stage 2A-C, an increase of approximately 67%. In patients with stage 2A-C, it increased from 16.2% to 29.1%, an increase of approximately 80%. 16.5% to 26.6% (approximately 60% percentage increase) for patients with 3A-C disease and unstaged disease.
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However, among patients with stage I rectal cancer, the rate of rectal resection increased by 6.1 percentage points, or approximately 30%, from 20.3% to 26.4%.
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Among patients who actually underwent surgery, the proportion with a complete pathologic response to neoadjuvant therapy nearly tripled, increasing from 6.5% to 18.8%.
in fact:
“This case series demonstrates that rectal cancer is increasingly being managed medically, especially among patients whose treatment has traditionally relied on proctectomy,” the authors concluded. ing. However, there is a lack of protocols to standardize this approach, so “establishing quality standards for organ preservation is an urgent task that requires the involvement of all stakeholders, including patients.”
sauce:
The study, led by Anthony Loria, MD, MSCI, of the University of Rochester, New York, was published online on November 9th. JAMA Oncology.
Limitations:
The proportion of people who required surgery for recurrence, patient and institutional factors associated with organ preservation, and overall survival outcomes were not addressed.
Disclosure:
No external funding was reported, and the investigators did not report any relevant financial relationships.
M. Alexander Otto is a physician assistant who earned a master’s degree in medicine and a degree in journalism from Newhouse. He is an award-winning medical journalist who worked for several major news organizations before joining Medscape. Alex is also an MIT Knight Fellow in Science Journalism. Email: aotto@mdedge.com