Introduction There is a lack of conclusive long-term studies evaluating risk and benefit in the surgical management of complete pathological response to rectal cancer. The trend in practice is becoming increasingly conservative, especially with an ageing population with increasing comorbidity, with recent data supporting a ‘watch and wait’ approach to complete responders. A recently published article utlilsing decision-analytical modelling predicted no difference in survival in 60 year old male patients between those managed conservatively and operatively. More interestingly they predicted a significant improvement in absolute survival in 80 year olds managed conservatively. Given the trend of the current evidence we aimed to determine the regional practice in Merseyside. We questioned whether increased age and/or comorbidity influenced surgeon decision when complete pathological response was detected.
Method A questionnaire was submitted to all the colorectal cancer surgeons within the greater Merseyside region, in the north west of England, United Kingdom. The participants were asked for their practice in managing 3 patient cohorts (60, 70, 80 years of age) with complete pathological response and of varying comorbid status. They were then asked for their preference should they be faced with the same clinical scenario personally.
Results 10 colorectal cancer units with 33 colorectal surgeons were surveyed. The response rate was 23/33 (70%). 5% of surgeons would offer surgery to 70–80 year old patients with multiple comorbidities, whereas 22% would if the patient was 60 years of age. 27% of surgeons would offer surgery to patients who were 80 years of age who had no medical comorbidities, and 55% would if they were 60 years of age with no comorbidities.
66% of surgeons would not want any surgery if they personally had a completely responding rectal cancer. 44% would want different treatment from what they would offer their patients. One surgeon would not routinely offer surgery but would personally want one.
Conclusion Patients with complete pathological response get different treatment according to surgeon preference in Merseyside. 44% of surgeons would advise their patients something they would not choose should they be faced with the same scenario. More study into the long-term risk and benefit of surgical vs. conservative management of complete responders is required, in order that surgeons can offer a more evidence based treatment for the patient, a treatment they would wish upon themselves.
Disclosure of interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.