Delisle Megan, Ivankovic Victoria, Goubran Doris, Paglicauan Eliane Yvonne, Alsobaei Mariam, Alcasid Nicole, Farnand Mary, Dennis Kristopher
Department of Surgery, University of Manitoba, Winnipeg, MB R3E 0W3, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
Curr Oncol. 2025 Jun 10;32(6):341. doi: 10.3390/curroncol32060341.
Organ preservation (OP) is an increasingly recognized treatment for locally advanced rectal cancer. However, variability in patient selection, treatment regimens, and surveillance can hinder widespread adoption. We conducted a national, cross-sectional survey evaluating how OP is implemented across Canada.
Between June and July 2023, surgeons, radiation oncologists, and medical oncologists with expertise in OP from all 44 Canadian radiation centers completed an electronic survey about the implementation of OP at their centers. Primary OP was defined as administering neoadjuvant therapy with the explicit goal of avoiding surgery. Secondary OP was defined as deferring planned surgery only when there was an unexpected yet sufficient clinical response.
Responses from 40 radiation centers (response rate 90.9%) identified that 20 (50.0%) offered primary and secondary OP, 11 (27.8%) offered only secondary, and 8 (20.0%) offered neither. The most common treatment in primary OP was chemoradiation with consolidation chemotherapy (17/20, 89.5%). When assessing the response in primary OP, endoscopic biopsies were more commonly performed with a near-complete response (10/20, 50.0%) than a complete response (4/20, 20.0%). Watch-and-wait surveillance was more frequently offered for a complete response (17/31, 54.8%) than a near-complete response (4/31, 12.9%). Challenges included limited MRI (21/40, 52.5%), clinic time (18/40, 45.0%), timely surgery if required (16/40, 40.0%), and limited familiarity with the protocols and evidence (15/40, 37.5%).
OP is recognized nationwide but is inconsistently implemented. Challenges raise concerns about the current feasibility of OP in Canada and highlight the need for less resource-intensive, complex OP protocols.
器官保留（OP）是一种越来越被认可的局部晚期直肠癌治疗方法。然而，患者选择、治疗方案和监测的差异可能会阻碍其广泛应用。我们进行了一项全国性横断面调查，以评估OP在加拿大的实施情况。
2023年6月至7月期间，来自加拿大所有44个放疗中心的具有OP专业知识的外科医生、放射肿瘤学家和医学肿瘤学家完成了一项关于其中心OP实施情况的电子调查。原发性OP被定义为以避免手术为明确目标进行新辅助治疗。继发性OP被定义为仅在出现意外但充分的临床反应时推迟计划中的手术。
40个放疗中心的回复（回复率90.9%）表明，20个（50.0%）提供原发性和继发性OP，11个（27.8%）仅提供继发性OP，8个（20.0%）两者均不提供。原发性OP中最常见的治疗方法是同步放化疗联合巩固化疗（17/20，89.5%）。在评估原发性OP的反应时，对于接近完全缓解（10/20，50.0%），内镜活检比完全缓解（4/20，20.0%）更常用。对于完全缓解（17/31，54.8%），观察等待监测比接近完全缓解（4/31，12.9%）更频繁。挑战包括MRI设备有限（21/40，52.5%）、门诊时间（18/40，45.0%）、必要时及时手术（16/40，40.0%）以及对方案和证据的熟悉程度有限（15/40，37.5%）。
OP在全国范围内得到认可，但实施情况不一致。这些挑战引发了对OP在加拿大当前可行性的担忧，并凸显了对资源消耗较少、更简单的OP方案的需求。
