Rectal Cancer in Young Adults: An Analysis of the US Rectal Cancer Consortium

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INTRODUCTION: The incidence of colorectal cancer (CRC) in young adults (YA) without any known genetic predisposition is increasing. We sought to identify risk factors in the development of rectal cancer (RC) in YA (<45 years) among a multi-institutional cohort of RC patients. METHODS: Patients without known inheritable syndromes or inflammatory bowel disease who underwent RC resection between 2007 and 2017 were identified using the US Rectal Cancer Consortium. YA were compared with patients 45 years or older based on identifiable risk factors, clinicopathological, and perioperative data. RESULTS: Among 1,153 patients who underwent resection for RC, we identified 120 (10.4%) YA. Compared with patients over 45 years old, YA more often had a family history of CRC (31.0% vs 20.0%; p = 0.01) and more commonly presented with a bowel obstruction (4.1% vs 1.1%; p = 0.02) or rectal bleeding (28.0% vs 17.0%; p = 0.005). Two-thirds (66.0%) of YA presents with advanced disease (stage 2 or worse) compared with only 52.7% in older patients (p = 0.02). After operation, both cohorts had similar postoperative length of stay, complication, and readmission rate (all p > 0.05). On molecular analysis, a higher proportion of YA were found to have mutations to the APC (5.4% vs 1.1%; p = 0.007) and p53 (4.3% vs 1.3%; p < 0.001) genes. There was no difference in mutation to the MSI, KRAS, and MSH genes. CONCLUSION: YA undergoing operation for RC presented with more advanced disease but had similar perioperative outcomes when compared with older patients. Further studies are needed to identify preventative and early recognition strategies for RC among high-risk YA.