GS2 - Postoperative Outcomes Among Rectal Cancer Patients That Fail Watch and Wait: Does Delaying Total Mesorectal Excision Lead to More Complications?

Sunday, June 2, 2024

10:27 AM – 10:30 AM ET, USA

Location: Room 314-317

Abstract Podium Presenter(s)

Hannah Williams, MD

Research Fellow
Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
New York, NY, United States

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

Author(s)

CL

Christina Lee, MD

Research Fellow
Memorial Sloan Kettering
New York, New York, United States

Disclosure information not submitted.
SL

Sabrina T. Lin, Master of Science

Biostatistician
Memorial Sloan Kettering
New York, New York, United States

Disclosure information not submitted.
LQ

Li-Xuan Qin, n/a

Attending Biostatistician
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Georgios Karagkounis, MD

Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Maria Widmar, MD, MPH, FACS (she/her/hers)

Assistant Attending
Memorial Sloan Kettering Cancer Center
Weill Cornell Medical Center
New York, New York, United States

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

Iris Wei, MD

Surgeon
Memorial Sloan Kettering Cancer Center
New York City, New York, United States

Disclosure information not submitted.
Emmanouil Pappou, MD, PhD

Assistant Attending
Memorial Sloan Kettering Cancer Center
new York, New York, United States

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This individual has no financial relationships with ineligible companies.
J. Joshua Smith, MD, PhD

Associate Attending
Memorial Sloan Kettering Cancer Center
MSKCC, Weill Cornell Medical College
New York, New York, United States

Disclosure information not submitted.
Garrett M. Nash, MD, MPH

Vice Chair, Department of Surgery
Memorial Sloan Kettering
New York, New York, United States

Disclosure information not submitted.
Martin Weiser, MD

Attending Surgeon and Professor
Memorial Sloan Kettering Cancer Center
Cornell Medical College
New York, New York, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
Philip B. Paty, FASCRS, FACS

Attending Surgeon, Colorectal Surgery Service
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.

Senior Author(s)

Julio Garcia-Aguilar, MD, PhD (he/him/his)

Chief Attending
Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.

Purpose/Background: Approximately 40% of rectal cancer patients who enter watch and wait (WW) surveillance will require a total mesorectal excision (TME) for residual disease. Concerns remain that longer intervals between end of neoadjuvant treatment and TME may increase the difficulty of surgical resection due to treatment-induced pelvic fibrosis. This study analyzed operative and postoperative outcomes among rectal cancer patients undergoing immediate or delayed TME for a non-complete response to total neoadjuvant therapy (TNT).

Methods/Interventions: Electronic medical records at a comprehensive cancer center were retrospectively reviewed from 2013 to 2021 for patients with stage II/III rectal adenocarcinoma who underwent TME after completing TNT. Patients were excluded if they had a prior history of pelvic radiation, previous diagnosis of rectal cancer, or metastatic disease diagnosed before TME. The delayed TME (dTME) group included patients initially offered WW who underwent surgery for residual disease more than 90 days after end of TNT. The immediate TME (iTME) group consisted of patients who had surgery within 90 days of completing neoadjuvant treatment. The primary outcome was 30-day morbidity, which was assessed using multivariable logistic regression analysis.

Results/Outcomes: Of the 276 patients included, 77 (27.9%) had a dTME at a median of 209 days from end of TNT. Patients in the dTME group were more likely to receive consolidation TNT (18% vs. 3.5%; p< 0.001) and to require an abdominoperineal resection (APR) (35% vs. 16%; p< 0.001) compared to those in the iTME group. Patient groups did not differ by surgical approach (open vs. minimally invasive), or by pathologic outcomes such as tumor differentiation, pathologic stage or resection margin status. There were no differences in intraoperative complications, operative time, length of stay, 30-day readmission or 30-day reoperation rates. A total of 78 (28.3%) patients had postoperative complications, including 30 (39%) in the dTME group and 48 (24.1%) in the iTME group (p=0.017). Only open surgery (OR 2.22; 95%CI 1.06-4.54) and APR (1.96; 95%CI 1.01-3.70) remained independent predictors of postoperative morbidity on a multivariable logistic regression analysis accounting for baseline characteristics, comorbidities, surgical history, type of operation and timing of TME (Table 1).

Conclusion/Discussion: Patients who fail to develop a sustained clinical complete response on WW surveillance undergo surgery many months after completing neoadjuvant treatment. Delaying TME does not compromise ability to obtain negative resection margins or place patients at increased risk for postoperative complications.