Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Department of Public Health Sciences, University of Rochester, Rochester, NY, USA.
Ann Surg Oncol. 2024 Nov;31(12):7798-7806. doi: 10.1245/s10434-024-16037-7. Epub 2024 Aug 15.
The treatment landscape for rectal cancer is rapidly evolving, particularly with the increasing use of neoadjuvant therapies. Still, up to 50% of patients with stage II-III disease require surgical resection post-neoadjuvant therapy to achieve the best oncologic outcomes. Many patients, however, hope to avoid surgery. This study aimed to assess trends and factors associated with declining recommended oncologic resection after systemic therapy nationally and in our institution.
This is a retrospective analysis using the National Cancer Database from 2009 to 2021 and an institutional cohort at an academic center between 2009 and 2022 including adults with stage I-III rectal adenocarcinoma who underwent neoadjuvant therapy and were suitable for surgery.
Of 96,997 patients nationally, the rate of declining surgery increased from 2.3% in 2009 to 6.3% in 2021, a trend mirrored in our institutional cohort of 365 patients (0% in 2009/2010 to approximately 6-12% in 2021/2022). Locally, patients who declined surgery had higher rates of tobacco use, temporary loss to follow-up during therapy, and a more robust, albeit incomplete, tumor response to neoadjuvant therapy compared with controls who underwent surgery. Despite a stoma being the most cited reason for declining surgery, 30.4% of patients who declined oncologic resection died with a stoma.
Our findings underscore a notable trend of patients declining oncologic resections following neoadjuvant therapy for rectal cancer. By shedding light on the outcomes of patients who opt against surgery, we address a critical gap in the literature essential for informing patients about potential risks.
直肠癌的治疗领域正在迅速发展，尤其是新辅助治疗的应用越来越广泛。然而，高达 50%的 II-III 期疾病患者在新辅助治疗后仍需要手术切除以获得最佳的肿瘤学结果。然而，许多患者希望避免手术。本研究旨在评估全国范围内和我们机构中接受系统治疗后推荐进行肿瘤切除的趋势和相关因素。
这是一项回顾性分析，使用了 2009 年至 2021 年期间的国家癌症数据库和一家学术中心的机构队列，包括接受新辅助治疗且适合手术的 I-III 期直肠腺癌成年患者。
在全国范围内的 96997 例患者中，手术切除率从 2009 年的 2.3%增加到 2021 年的 6.3%，我们机构队列的 365 例患者也呈现出同样的趋势（2009/2010 年为 0%，2021/2022 年约为 6-12%）。在局部地区，与接受手术的对照组相比，选择不进行手术的患者更有可能吸烟、治疗期间暂时失去随访，且对新辅助治疗的肿瘤反应更为强烈（尽管并不完全）。尽管造口是拒绝手术的最主要原因，但仍有 30.4%的拒绝肿瘤切除的患者最终死于带造口的疾病。
我们的研究结果强调了接受新辅助治疗后患者拒绝进行肿瘤切除的显著趋势。通过揭示选择不进行手术的患者的结局，我们填补了文献中的一个关键空白，为患者提供潜在风险的信息至关重要。
