Trends in organ preservation in rectal cancer management: A population-based study in the Netherlands

Introduction This population-based study aims to provide an overview of organ preservation (OP) trends in rectal cancer treatment in the Netherlands. Materials and methods Data from patients with non-metastatic stage I–III rectal cancer, diagnosed between 2009–2023 and recorded in the Netherlands Cancer Registry (NCR), were analysed. Trends in treatment patterns and OP rates were assessed across different therapeutic modalities and time periods. OP was defined as the avoidance of radical TME surgery during primary treatment. Results Treatment strategies for 44 579 patients with stage I–III rectal cancer were analysed, of whom 12 407 (26.3 %) underwent primary TME-surgery. Primary local excision (LE) was performed in 7 132 (16.0 %) patients, increasing from 236 (8.6 %) patients in 2009–573 (25.3 %) in 2023. Among LE patients, 5 957 (83.5 %) achieved OP, while 1 175 (16.5 %) underwent additional TME resection. Initial treatment with (chemo)radiation was administered to 25,040 (53.2 %) patients, resulting in OP for 4 885 (19.5 %) patients: 4 337 treated with (chemo)radiation alone. After (chemo)radiation, 20 139 (80.4 %) underwent TME, of whom 2 014 (10.0 %) had ypT0N0 and 1 222 (6.1 %) had ypT1N0 tumours. There was an increasing trend in OP after (chemo)radiation from 6.6 % in 2009–44.9 % in 2023. Overall, OP rates for rectal cancer patients increased from 9.6 % in 2009–40.9 % in 2023. Discussion This study highlights a paradigm shift in primary rectal cancer treatment in the Netherlands, driven by the gradual implementation of organ-preserving strategies. In 2023, more than 40 % of rectal cancer patients reached OP.