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Session:: ePosters-Mon120-M1: Rectal Cancer

EP857 - Trends in the Management of Rectal Adenocarcinoma from 2010 to 2022, A National Cancer Database Analysis

Monday, May 11, 2026
1:58 PM - 2:03 PM ET

    ePoster Presenter(s)

  • Ryan Meyer, MD (he/him/his)

    General Surgery Resident
    Los Robles Regional Medical Center
    Thousand Oaks, CA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • DC

    David Chi, MD FACS, MD

    Attending
    Los Robles Hospital
    Thousand Oaks, California, United States

    Disclosure information not submitted.

    • Author(s)

  • ZH

    Zin M. Htway, PhD, MBA, CT (ASCP, IAC)

    Supervisor Anatomic Pathology
    HCA Los Robles Hospital and Medical Center
    Thousand Oaks, California, United States

    Disclosure information not submitted.

  • TW

    Tyler Wilson, MD

    General Surgery Resident
    HCA Los Robles Regional Medical Center
    THOUSAND OAKS, California, United States

    Disclosure information not submitted.

  • SP

    Shivam Pandya, MD

    Resident Physician
    Los Robles Regional Medical Center Department of Surgery
    Thousand Oaks, California, United States

    Disclosure information not submitted.

Purpose/Background: Landmark trials regarding the utility of total neoadjuvant therapy (TNT) and selective watch & wait (W&W) strategies in the last decade have changed the overall management options for rectal adenocarcinoma.

Methods/Interventions: This is a retrospective cohort study using the National Cancer Database (NCDB). We identified patients with stage I-III rectal adenocarcinoma between the years 2010 and 2022 and analyzed management trends. Management options examined included: 1) sphincter-preserving surgery (SPS) to include patients who had undergone low anterior resection, resection with coloanal anastomosis, or local resection; 2) non-sphincter-preserving surgery (NSPS) to include abdominoperineal resection and proctectomy procedures; and 3) watch and wait (W&W). Outcomes examined were annual proportion of each management strategy and non-sphincter preserving surgery among surgical patients.

Results/Outcomes: 161,515 patients met our inclusion criteria with yearly incidence steadily increasing from 10,049 to 15,181. Our four management categories accounted for 141,304 patients (87.5%) of patients in this time period. The percentage of patients undergoing W&W increased almost fivefold during this time, from 4% (447/10,049) in 2010 to 19% (2697/12,100) in 2022. During this time, SPS declined from 65% (6560/10049) to 54% (7787/14448), while NSPS declined from 19% (1947/10,049) to 10% (1458/14,448). Utilization of surgery defined as SPS plus NSPS fell from 84.6% (8507/10,049) in 2010 to 64% (9245/14,448). Among patients who underwent surgery, the share of NSPS decreased from 22.9% (1947/8507) in 2010 to 15.8% (28555/14,448) in 2022 , an absolute reduction of 7.1 points.

Conclusion/Discussion: Across the NCDB from 2010 to 2022, management of stage I-III rectal adenocarcinoma shifted substantially towards organ preservation; with the number of patients undergoing watch and wait increasing substantially. Non-sphincter preserving surgery also declined both overall and within surgical patients. These data suggest national uptake of non-operative strategies and improved sphincter preservation among those undergoing surgery.

Management Trends in Stage I-III Rectal Adenocarcinoma 2010-2022