Retrospective study of trends in organ preservation among rectal cancer patients in the USA, 2006-2020

In March 2023, the National Comprehensive Cancer Network endorsed watch and wait for rectal cancer patients with complete clinical response to total neoadjuvant therapy. This therapy is highly efficacious, so this recommendation may have broad implication, but the current trends in organ preservation are unknown. A retrospective observational study using the National Cancer Database found that among 175,545 US adults with rectal cancer treated with curative intent from 2006 to 2020, there was a statisically significant increase in the absolute annual proportion of organ preservation among patients with stage II and III disease. Increased organ preservation was associated with increased multimodal therapy without tumor resection, rather than increased transanal local excisions. The authors conclude that rectal cancer is increasingly being managed medically, and new quality standards and core outcome sets are urgently needed to ensure high-quality care delivery responsive to these trends.