Document Type

Conference Proceeding

Publication Date

5-15-2025

Abstract

Introduction: Patients with stage II/III rectal cancer may be recommended total mesorectal excision (TME) or a watch-and-wait (WW) approach depending on clinical response to total neoadjuvant therapy (TNT). In shared decision-making, patients may decide for or against surgery regardless of recommendation. This study aimed to describe the clinical outcomes of patients with locally advanced rectal cancer (LARC) who decide against physician recommendations. Methods: A retrospective cohort study of all patients diagnosed with AJCC clinical stage II/III LARC between 2021-2023 and treated at a single tertiary center with TNT was performed. Patients with IBD, genetic syndromes, synchronous tumors, those who did not receive TNT, and those without follow up were excluded. Patients were sorted into subgroups based on tumor response and decision regarding recommended approach (TME versus WW). Primary outcomes were clinical complete response (cCR) and pathologic complete response (pCR). Results: Of 151 patients, 66 met inclusion criteria. 48.5% (n=32) were recommended WW. Four chose TME; of these, 2 had sterile specimens. The remaining 34 were recommended TME. Four chose WW. Of these four, three remain alive greater than one year after TNT (Figure 1). Of the 30 patients who underwent TME, 8 had sterile specimens. In total, 38 out of 66 patients achieved cCR or pCR (57.6%). Conclusion: Our rates of clinical and pathologic responses suggests that optimal outcomes can be achieved even when patients opt against recommendations. Future research regarding insight into patient decision-making given WW or TME could inform physician-patient counseling.

Comments

Michigan Chapter of the American College of Surgeons 71st Annual Meeting, May 14-16, 2025, Bellaire, MI

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