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Session: ePoster Monitor 6-Rectal Cancer 1

eP216 - Operative Trends Following the Adoption of Nonoperative Management of Rectal Cancer

Sunday, June 2, 2024
9:18 AM – 9:23 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Maseray S. Kamara, MD (she/her/hers)

    Colon & Rectal Surgery Fellow
    Trinity Health Ann Arbor
    Ann Arbor, MI, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • MH

    Marianne Huebner, PhD

    Professor
    Michigan State University
    East Lansing, Michigan, United States

    Disclosure information not submitted.

  • ET

    Elias Taxakis, MD

    Diagnostic Radiologist
    Huron Valley Radiology
    Ann Arbor, Michigan, United States

    Disclosure information not submitted.

  • CR

    Carole Ramm, MS, RN

    Staff
    Trinity Health Ann Arbor
    Ypsilanti, Michigan, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Robert K. Cleary, MD

    Program Director Colon and Rectal Surgery
    Trinity Health Ann Arbor
    Trinity Health
    Ann Arbor, Michigan, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no relevant relationships with ineligible companies.

Purpose/Background: Nonoperative management of rectal cancer is an option for patients with a clinical complete response (cCR) to total neoadjuvant therapy (TNT). Though MRI protocols have improved staging accuracy in recent years, differentiating near-complete and complete response to TNT may be challenging, especially for low rectal cancers. We hypothesized that staging limitations for low rectal cancers would increase the proportion of patients undergoing abdominoperineal resection with permanent colostomy for those without a cCR to TNT.Methods/Interventions: This is a single institution retrospective analysis comparing rectal cancer cases before (pre-W&W) and after (post-W&W) implementation of a nonoperative “watch and wait” pathway in 2017. Abdominoperineal resection (APR) as a percentage of rectal resections was the primary outcome. Secondary outcomes included pathologic total mesorectal excision (TME) grade and pathologic complete response, and outcomes for patients with cCR to TNT including tumor regrowths and salvage surgery.Results/Outcomes: 174 patients met inclusion criteria with 76 TMEs in the pre-W&W group and 98 TMEs in the post-W&W group. TNT prior to surgery (p < 0.001) and the robotic surgical approach (75.0% vs 90.8%, p=0.002) were significantly more common in the post-W&W group. There was no significant difference between groups in the APR primary outcome (pre-W&W APR 33.3% vs post-W&W APR 26.5%, p=0.482). APR patients had fewer complete TME grades (69.2% vs 46.2%) and more pathologic complete responses (0% vs 26.9%) in the post-W&W period. The cCR rate for patients with nonoperative management was 51.4% (n=37) and 13.5% (n=5) had regrowths, all of whom underwent salvage surgery. The rectal preservation rate was 94.6% in the nonoperative management cohort.Conclusion/

Discussion: Clinical staging limitations for low rectal cancers have not resulted in a proportional increase in abdominoperineal resection for those without a clinical complete response to total neoadjuvant therapy in the nonoperative management era. The pathologic complete response rate may be high when patients with clinical near-complete responses are offered operative intervention and many of these patients may benefit from repeat restaging.Table. Variables and Outcomes