Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Surgery, Harvard Medical School, Boston, Massachusetts.
J Surg Oncol. 2020 May;121(6):990-1000. doi: 10.1002/jso.25873. Epub 2020 Feb 23.
Surgical resection is a cornerstone in the management of patients with rectal cancer. Patients may refuse surgical treatment for several reasons although the rate of refusal is currently unknown.
The National Cancer Database was utilized to identify patients with stage I-III rectal cancer. Patients who refused surgical resection were compared to patients who underwent curative resection.
A total of 509 (2.6%) patients with stage I and 2082 (3.5%) patients with stage II/III rectal cancer refused surgery. In multivariable analysis for stage I disease, older age, Black race, and Medicaid/no insurance were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had a higher income or lived further distances from the treatment facility. In multivariable analysis for stage II/III disease, older age, Black race, insurance other than private, and rural county were independent predictors of surgery refusal. Patients were less likely to refuse surgery if they had higher Charlson comorbidity scores, lived further distances from the treatment facility, or underwent chemoradiation. There was a significant decrease in survival for patients refusing surgery compared to patients undergoing recommended surgery.
A small proportion of patients refuse surgery for rectal cancer, and this treatment decision significantly affects survival.
手术切除是治疗直肠癌患者的基石。尽管目前尚不清楚拒绝手术治疗的比例，但患者可能因多种原因拒绝手术。
本研究利用国家癌症数据库（National Cancer Database）确定了 I-III 期直肠癌患者。将拒绝手术切除的患者与接受根治性手术切除的患者进行比较。
在 I 期疾病的多变量分析中，年龄较大、黑种人、医疗补助/无保险是拒绝手术的独立预测因素。收入较高或距离治疗机构较远的患者更不容易拒绝手术。在 II/III 期疾病的多变量分析中，年龄较大、黑种人、非私人保险以及农村县是拒绝手术的独立预测因素。Charlson 合并症评分较高、距离治疗机构较远或接受放化疗的患者不太可能拒绝手术。与接受推荐手术的患者相比，拒绝手术的患者的生存率显著降低。
一小部分直肠癌患者拒绝手术，而这种治疗决策对生存有显著影响。
