eP676 - Organ Preservation in Elderly Patients with Stage I Rectal Cancer

Purpose/Background: While the National Comprehensive Cancer Network guidelines recommend total mesorectal resection (TME) as the primary treatment for stage I rectal cancer, there is growing evidence to suggest that preoperative systemic therapy may lead to eligibility for organ-sparing resection. Avoidance of morbidity associated with TME is beneficial to patients, especially those of advanced age. The primary aim was to examine trends in organ preservation rates in patients with stage I rectal cancer in elderly patients. We hypothesize that advanced age would be predictive of receipt of chemotherapy and/or radiation (chemoXRT) with associated avoidance of TME.Methods/Interventions: Adult patients diagnosed with high risk cT1 or cT2 and cN0M0 rectal cancer from 2004-2020 within the National Cancer Database who received any form of treatment were divided into cohorts by age, with patients ≥70 years of age considered elderly. Primary outcome of receipt of TME +/- chemoXRT was compared between the cohorts. Receipt of any combination of neoadjuvant chemoXRT with no surgery or local excision was considered organ preservation. Univariate distributions were compared using chi-square. Multivariable logistic regression was performed to evaluate factors predictive based on univariate regression.Results/Outcomes: 38,714 patients were included, 34.4% were elderly, 42.3% were female, and 75.6% had a Charlson-Deyo comorbidity score of 0. More elderly patients (45.5%) received organ preservation compared to non-elderly patients (30.6%, p < 0.001). On regression, elderly patients had significantly higher odds of receiving organ preservation compared to non-elderly patients (OR 1.9, p < 0.001). Other factors predictive of receiving organ preservation include black race compared to white race (OR 1.5, p < 0.001), advanced comorbidity (OR 1.7 for CDCC of 3, p < 0.001), and female sex (OR 1.2, p < 0.001). These patterns persisted on multivariable regression. Factors associated with decreased likelihood of receiving organ preservation include Asian and Pacific Islander race, private insurance, residing in a metropolitan area, and receiving care at any facility type other than community site.Conclusion/

Discussion: Although current guideline recommendations for stage I rectal cancer is TME, a large proportion of patients with stage I rectal cancer undergo organ preservation. This is more pronounced in elderly patients, comorbid patients, and disadvantaged patients.