P202 - Comparative Outcomes of Organ-Preserving Surgery vs. Radical Resection for Clinical T2N0M0 Rectal Cancer: A Retrospective Analysis

Sunday, May 11, 2025

12:52 PM – 12:58 PM PT

Location: Ballroom 6B, Upper Level

Abstract Podium Presenter(s)

JW

Joseph M. Wetherell, MD

Resident Physician
LifeBridge Health
Towson, MD, United States

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

Author(s)

Matthew Zeller, DO (he/him/his)

Surgical Resident
Sinai Hospital of Baltimore
Baltimore, MD, United States

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

Joseph J. Bennett, MD

System Chief of Surgery
LifeBridge Health
Baltimore, Maryland, United States

Disclosure information not submitted.
JF

Jessica Felton, MD, MS

Physician
Lifebridge Health
Baltimore, Maryland, United States

Disclosure information not submitted.
PK

Pallavi P. Kumar, M.D.

Division Director, Medical Oncology
Lifebridge Health, Sinai Hospital
Baltimore, Maryland, United States

Disclosure information not submitted.
AS

Andrea Paola P. Solis Pazmino, 1804664892

Surgery Resident
Surgery Group Los Angeles
Porto Alegre, Rio Grande do Sul, Brazil

Disclosure information not submitted.
MB

Moshe Barnajian, n/a

Colorectal Surgery
Surgery Group Los Angeles
Los Angeles, California, United States

Disclosure information not submitted.
Yosef Nasseri, MD, FACS, FASCRS

General and colorectal surgeron
Cedar-Sinai Medical Center
Los Angeles, CA, United States

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

Senior Author(s)

JW

Joshua Wolf, MD FACS FASCRS

Division Chief, Colorectal Surgery
LifeBridge Health
Baltimore, Maryland, United States

Disclosure information not submitted.

Submitting Author(s)

JW

Joseph M. Wetherell, MD

Resident Physician
LifeBridge Health
Towson, MD, United States

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

All of the relevant financial relationships listed below have been mitigated.

Joseph M. Wetherell, MD: This individual has no financial relationships with ineligible companies.

Matthew Zeller, DO: This individual has no financial relationships with ineligible companies.

Yosef Nasseri, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: A distinct subset of patients with clinical T2N0M0 rectal cancer within the ACS-NCDB underwent organ-preserving surgery (OPS) and/or received neoadjuvant therapy, diverging from established national guidelines. This study aims to define this population and evaluate the impact of surgical approach and neoadjuvant therapy on overall survival.

Methods/Interventions: This retrospective study utilized data from the American College of Surgeons National Cancer Database (ACS-NCDB) for patients diagnosed with clinical T2N0M0 rectal cancer between 2006 and 2021. Patients were categorized into two groups: those who underwent organ-preserving surgery (OPS) and those who received radical resection (RR; LAR or APR). OPS was defined as a case in which the definitive cancer operation was listed as either transanal or wide local excision. Demographic and clinical characteristics were compared between the groups using the paired t-test, Chi-square test, and Fisher’s exact test where appropriate, and trends in treatment approaches were assessed over time. Subgroup analyses were also done comparing neoadjuvant therapy versus no treatment within OPS and RR. Survival analyses were performed using Kaplan-Meier methods. Statistical significance was set at p < 0.05.

Results/Outcomes: A total of 11,513 patients with clinical T2N0M0 rectal cancer were included in the analysis, with 1,853 (16.1%) undergoing OPS. Compared to patients who underwent RR, OPS patients were older with increased Charlson-Deyo comorbidity scores and had higher frequencies of female sex and Medicare insurance (all p < 0.001). The rate of OPS remained stable when comparing 2006 and 2021 (18.3% vs 15.1%, p = 0.15) (Figure 1). The overall rates of patients receiving neoadjuvant therapy decreased in the total T2N0M0 cohort (45.5% to 18.5%, p < 0.001), as well as in OPS (30.1% vs 11.5%, p = 0.002), and RR groups (48.9% vs 19.8%, p < 0.001) (Figure 2). Over all years, OPS was associated with a lower frequency of patients receiving any neoadjuvant treatment (21.7% vs. 30.3%, p < 0.001), neoadjuvant radiation therapy alone (3.0% vs. 8.2%, p < 0.001), and combination chemotherapy plus radiotherapy (16.5% vs. 20.4%, p < 0.001). In terms of survival, OPS was linked to lower 5-year survival compared to RR (65.4% vs 77.2%, p < 0.001). This trend held for patients receiving no neoadjuvant therapy (64.0% vs 77.2%, p < 0.001), neoadjuvant radiation (64% vs 78.6%, p = 0.0019), and combination neoadjuvant therapy (70.6% vs 76.7%, p = 0.0092).

Conclusion/Discussion: This study highlights that a notable proportion of patients with clinical T2N0M0 rectal cancer are receiving OPS and neoadjuvant therapy against national recommendations. Our findings indicate that OPS is associated with higher risk patients compared to RR and show that over time the use of neoadjuvant therapy has decreased, both in OPS and RR. In Kaplan Meier survival analysis, OPS was associated with decreased survival when compared to RR. To account for possible selection bias and other potential clinical confounders, co-variate adjusted analyses measuring the associations between surgery type, neoadjuvant therapy, and patient survival are the subject of ongoing investigations.