Changes in rectal cancer treatment after the introduction of a national screening program; Increasing use of less invasive strategies within a national cohort

C Verhoef,M.A.G Elferink,L.J.X Giesen,J.W.T Dekker,G.L Beets,P.B Olthof,H.L Van Westreenen

doi:10.1016/j.ejso.2021.11.132

Abstract

AimOrgan preserving treatment strategies and the introduction of a colorectal cancer-screening program have likely influenced the resection rates of rectal cancer. The aim of this study is to assess the influence of these developments on rectal cancer treatment and resection rates in the Netherlands. MethodsPatients diagnosed with non-metastatic rectal cancer between 2013 and 2018, were selected from the Netherlands Cancer Registry. The distribution of surgical and neo-adjuvant treatment and resection rates were analyzed and compared over time. ResultsBetween 2013 and 2018 22640 patients were diagnosed with non-metastatic rectal cancer. The incidence of early stage (cT1) disease increased from 141 (4%) in 2013 to 448 (12%) in 2018. The use of neoadjuvant radiotherapy and chemo-radiotherapy dropped from 39% to 21% and 34%–25%, respectively. A decrease in surgical resection rates (including TEM) was observed from 85% to 73%. The proportion of patients who underwent endoscopic resections increased from 3% to 10%. The decrease in surgical resection rates was larger in patients treated with neo-adjuvant chemo-radiotherapy. ConclusionAn increase in stage I disease is noted after the introduction of the screening program. Surgical resection rates for rectal cancer have fallen over time. Endoscopic resections due to more early-stage disease probably accounts for a large part of this decline. Furthermore, a watch and wait approach after neo-adjuvant chemo-radiotherapy may play an important role as well.

Highlights

For the past 25 years, the incidence of colorectal cancer has increased [1]
Data of patients diagnosed with non-metastatic rectal and rectosigmoid cancer between 2013 and 2018 were obtained from the Netherlands Cancer registry (NCR)
The numbers seem to stabilize after an increase in the first year of the screening program

Summary

Introduction

For the past 25 years, the incidence of colorectal cancer has increased [1]. Treatment of rectal cancer has shifted towards less invasive and more organ preserving treatment strategies. While total mesorectal excision (TME surgery) remains the gold standard for rectal cancer, it is associated with significant morbidity. Organ preserving surgery has emerged for early-stage rectal cancer and endoscopic resection options like endoscopic submucosal dissection (ESD) and endoscopic full thickness resection (EFTR) are increasing [3e6]. A colorectal cancer screening program was gradually launched in 2014 in the Netherlands [7]. This may probably result in more early stage rectal cancers as reported by previous studies from other countries

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Methods

Conclusion