Oncologic Risk of Rectal Preservation Against Medical Advice After Chemoradiotherapy for Rectal Cancer: A Multicenter Comparative Cross-Sectional Study with Rectal Preservation as Supported by Surgeon
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Rectal preservation against medical advice after neoadjuvant chemoradiotherapy for rectal cancer may increase oncologic uncertainty. This study aimed to compare the oncologic outcomes of patients undergoing rectal preservation as intended by the surgeon, and the outcomes of patients refusing rectal resection against medical advice.
The study population consisted of patients in whom the rectum was preserved after neoadjuvant chemoradiotherapy for clinical stage I–III mid or low rectal cancer between May 2003 and August 2017 (n = 2883); these patients were divided into those in whom rectal preservation was intended by their surgeon (intended rectal preservation, group A, n = 41) and those in whom the rectum was not resected against medical advice (unintended rectal preservation, group B, n = 101), defined as non-operative management or local excision.
The tumor distance, age, and performance status of patients were not significantly different between the groups, while the clinical T stage before chemoradiotherapy was lower in group A than in group B (P < 0.001). During the median follow-up period of 34 months (interquartile range 18.0–72.0 months), the 3-year overall survival in group B (59.7%) was worse than that in group A (90.1%; P < 0.001), and 80.2% of group B patients had residual or unknown disease status.
This study showed that unintended rectal preservation increases oncologic risk after neoadjuvant chemoradiotherapy for rectal cancer regardless of short-term follow-up. Therefore, these findings could be shared with rectal cancer patients who choose to ignore medical advice after chemoradiotherapy to preserve their rectum.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human rights and informed consent
Institutional review boards of the three included hospitals reviewed this study and waived the requirement for informed consent on the basis of its retrospective design and minimal risk to the participants. However, method was conducted in accordance with the committee’s approved guidelines to protect patients’ health information.
- 4.Garcia-Aguilar J, Renfro LA, Chow OS et al (2015) Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(15)00215-6 Google Scholar
- 16.Habr-Gama A, Perez RO, Nadalin W et al (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711Google Scholar
- 23.Margolis ML, Christie JD, Silvestri GA et al (2003) Racial differences pertaining to a belief about lung cancer surgery: results of a multicenter survey. Ann Intern Med. https://doi.org/10.7326/0003-4819-139-7-200310070-00007 Google Scholar
- 28.Abrams MJ, Koffer PP, Leonard KL (2016) The emerging non-operative management of non-metastatic rectal cancer: a population analysis. Anticancer Res 36:1699–1702Google Scholar