Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes

Vincent M Meyer; Richtje R Meuzelaar; Ivonne J H Schoenaker; Jan-Willem B de Groot; Onne Reerink; Wouter H de Vos Tot Nederveen Cappel; Geerard L Beets; Henderik L van Westreenen

doi:10.1097/DCR.0000000000002259

Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes

Vincent M Meyer^*, Richtje R Meuzelaar, Ivonne J H Schoenaker, Jan-Willem B de Groot, Onne Reerink, Wouter H de Vos Tot Nederveen Cappel, Geerard L Beets, Henderik L van Westreenen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: A watch & wait strategy for patients with rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy is a valuable alternative for rectal resection. However, there are patients who will have residual tumor or regrowth during watch & wait.

OBJECTIVE: The aim was to investigate safety and costs for patients who underwent delayed surgery after neoadjuvant chemoradiotherapy.

DESIGN: This is a retrospective cohort study with prospectively collected data.

SETTINGS: The study was conducted at a large teaching hospital.

PATIENTS: Between Jan 2015 - May 2020, 622 new rectal cancer patients were seen of which 200 received neoadjuvant chemoradiotherapy. Ninety-four patients were included of which 65 patients underwent immediate surgery and 29 patients required delayed surgery after an initial watch & wait approach.

MAIN OUTCOME MEASURES: This included 30-day postoperative morbidity rate, hospital costs and two-year overall and disease-free survival.

RESULTS: There was no difference in length of stay (9 vs 8, p = 0.83), readmissions (27.6% vs 10.0%, p = 0.10), surgical re-interventions (15.0% vs 3.4%, p = 0.16) and stoma free rate (52.6% vs 31.0%, p = 0.09) between immediate and delayed surgery groups. Hospital costs were similar in the delayed group (€11913 vs €13769, p = 0.89). Two-year overall survival (93% vs 100%, p = 0.23) and disease-free survival (78% vs 81%, p = 0.47) rates were comparable.

LIMITATIONS: Small sample size, follow-up time and retrospective design.

CONCLUSION: Delayed surgery for regrowth in a watch & wait program or for persistent residual disease after a repeated assessment is not associated with an increased risk of postoperative morbidity or a significant rise in costs compared to immediate total mesorectal excision. There also appears to be no evident compromise in oncological outcome. Repeated response assessment in patients with a near complete clinical response after neoadjuvant chemoradiotherapy is a useful approach to identify more patients who can benefit from a watch & wait strategy. See Video Abstract at http://links.lww.com/DCR/B836 .

Original language	English
Pages (from-to)	671-680
Journal	Diseases of the Colon & Rectum
Volume	66
Issue number	5
Early online date	24 Nov 2021
DOIs	https://doi.org/10.1097/DCR.0000000000002259
Publication status	Published - 2023

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10.1097/DCR.0000000000002259

Cite this

Meyer, V. M., Meuzelaar, R. R., Schoenaker, I. J. H., de Groot, J-W. B., Reerink, O., de Vos Tot Nederveen Cappel, W. H., Beets, G. L., & van Westreenen, H. L. (2023). Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes. Diseases of the Colon & Rectum, 66(5), 671-680. https://doi.org/10.1097/DCR.0000000000002259

@article{8a5383a1ad2847ffa2576136a3292a79,

title = "Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes",

abstract = "BACKGROUND: A watch & wait strategy for patients with rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy is a valuable alternative for rectal resection. However, there are patients who will have residual tumor or regrowth during watch & wait.OBJECTIVE: The aim was to investigate safety and costs for patients who underwent delayed surgery after neoadjuvant chemoradiotherapy.DESIGN: This is a retrospective cohort study with prospectively collected data.SETTINGS: The study was conducted at a large teaching hospital.PATIENTS: Between Jan 2015 - May 2020, 622 new rectal cancer patients were seen of which 200 received neoadjuvant chemoradiotherapy. Ninety-four patients were included of which 65 patients underwent immediate surgery and 29 patients required delayed surgery after an initial watch & wait approach.MAIN OUTCOME MEASURES: This included 30-day postoperative morbidity rate, hospital costs and two-year overall and disease-free survival.RESULTS: There was no difference in length of stay (9 vs 8, p = 0.83), readmissions (27.6% vs 10.0%, p = 0.10), surgical re-interventions (15.0% vs 3.4%, p = 0.16) and stoma free rate (52.6% vs 31.0%, p = 0.09) between immediate and delayed surgery groups. Hospital costs were similar in the delayed group (€11913 vs €13769, p = 0.89). Two-year overall survival (93% vs 100%, p = 0.23) and disease-free survival (78% vs 81%, p = 0.47) rates were comparable.LIMITATIONS: Small sample size, follow-up time and retrospective design.CONCLUSION: Delayed surgery for regrowth in a watch & wait program or for persistent residual disease after a repeated assessment is not associated with an increased risk of postoperative morbidity or a significant rise in costs compared to immediate total mesorectal excision. There also appears to be no evident compromise in oncological outcome. Repeated response assessment in patients with a near complete clinical response after neoadjuvant chemoradiotherapy is a useful approach to identify more patients who can benefit from a watch & wait strategy. See Video Abstract at http://links.lww.com/DCR/B836 .",

author = "Meyer, {Vincent M} and Meuzelaar, {Richtje R} and Schoenaker, {Ivonne J H} and {de Groot}, {Jan-Willem B} and Onne Reerink and {de Vos Tot Nederveen Cappel}, {Wouter H} and Beets, {Geerard L} and {van Westreenen}, {Henderik L}",

note = "Copyright {\textcopyright} 2021 The American Society of Colon and Rectal Surgeons.",

year = "2023",

doi = "10.1097/DCR.0000000000002259",

language = "English",

volume = "66",

pages = "671--680",

journal = "Diseases of the Colon & Rectum",

issn = "0012-3706",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "5",

}

Meyer, VM, Meuzelaar, RR, Schoenaker, IJH, de Groot, J-WB, Reerink, O, de Vos Tot Nederveen Cappel, WH, Beets, GL & van Westreenen, HL 2023, 'Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes', Diseases of the Colon & Rectum, vol. 66, no. 5, pp. 671-680. https://doi.org/10.1097/DCR.0000000000002259

Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes. / Meyer, Vincent M; Meuzelaar, Richtje R; Schoenaker, Ivonne J H et al.
In: Diseases of the Colon & Rectum, Vol. 66, No. 5, 2023, p. 671-680.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer

T2 - An Analysis of Hospital Costs, Surgical, and Oncological Outcomes

AU - Meyer, Vincent M

AU - Meuzelaar, Richtje R

AU - Schoenaker, Ivonne J H

AU - de Groot, Jan-Willem B

AU - Reerink, Onne

AU - de Vos Tot Nederveen Cappel, Wouter H

AU - Beets, Geerard L

AU - van Westreenen, Henderik L

PY - 2023

Y1 - 2023

N2 - BACKGROUND: A watch & wait strategy for patients with rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy is a valuable alternative for rectal resection. However, there are patients who will have residual tumor or regrowth during watch & wait.OBJECTIVE: The aim was to investigate safety and costs for patients who underwent delayed surgery after neoadjuvant chemoradiotherapy.DESIGN: This is a retrospective cohort study with prospectively collected data.SETTINGS: The study was conducted at a large teaching hospital.PATIENTS: Between Jan 2015 - May 2020, 622 new rectal cancer patients were seen of which 200 received neoadjuvant chemoradiotherapy. Ninety-four patients were included of which 65 patients underwent immediate surgery and 29 patients required delayed surgery after an initial watch & wait approach.MAIN OUTCOME MEASURES: This included 30-day postoperative morbidity rate, hospital costs and two-year overall and disease-free survival.RESULTS: There was no difference in length of stay (9 vs 8, p = 0.83), readmissions (27.6% vs 10.0%, p = 0.10), surgical re-interventions (15.0% vs 3.4%, p = 0.16) and stoma free rate (52.6% vs 31.0%, p = 0.09) between immediate and delayed surgery groups. Hospital costs were similar in the delayed group (€11913 vs €13769, p = 0.89). Two-year overall survival (93% vs 100%, p = 0.23) and disease-free survival (78% vs 81%, p = 0.47) rates were comparable.LIMITATIONS: Small sample size, follow-up time and retrospective design.CONCLUSION: Delayed surgery for regrowth in a watch & wait program or for persistent residual disease after a repeated assessment is not associated with an increased risk of postoperative morbidity or a significant rise in costs compared to immediate total mesorectal excision. There also appears to be no evident compromise in oncological outcome. Repeated response assessment in patients with a near complete clinical response after neoadjuvant chemoradiotherapy is a useful approach to identify more patients who can benefit from a watch & wait strategy. See Video Abstract at http://links.lww.com/DCR/B836 .

AB - BACKGROUND: A watch & wait strategy for patients with rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy is a valuable alternative for rectal resection. However, there are patients who will have residual tumor or regrowth during watch & wait.OBJECTIVE: The aim was to investigate safety and costs for patients who underwent delayed surgery after neoadjuvant chemoradiotherapy.DESIGN: This is a retrospective cohort study with prospectively collected data.SETTINGS: The study was conducted at a large teaching hospital.PATIENTS: Between Jan 2015 - May 2020, 622 new rectal cancer patients were seen of which 200 received neoadjuvant chemoradiotherapy. Ninety-four patients were included of which 65 patients underwent immediate surgery and 29 patients required delayed surgery after an initial watch & wait approach.MAIN OUTCOME MEASURES: This included 30-day postoperative morbidity rate, hospital costs and two-year overall and disease-free survival.RESULTS: There was no difference in length of stay (9 vs 8, p = 0.83), readmissions (27.6% vs 10.0%, p = 0.10), surgical re-interventions (15.0% vs 3.4%, p = 0.16) and stoma free rate (52.6% vs 31.0%, p = 0.09) between immediate and delayed surgery groups. Hospital costs were similar in the delayed group (€11913 vs €13769, p = 0.89). Two-year overall survival (93% vs 100%, p = 0.23) and disease-free survival (78% vs 81%, p = 0.47) rates were comparable.LIMITATIONS: Small sample size, follow-up time and retrospective design.CONCLUSION: Delayed surgery for regrowth in a watch & wait program or for persistent residual disease after a repeated assessment is not associated with an increased risk of postoperative morbidity or a significant rise in costs compared to immediate total mesorectal excision. There also appears to be no evident compromise in oncological outcome. Repeated response assessment in patients with a near complete clinical response after neoadjuvant chemoradiotherapy is a useful approach to identify more patients who can benefit from a watch & wait strategy. See Video Abstract at http://links.lww.com/DCR/B836 .

U2 - 10.1097/DCR.0000000000002259

DO - 10.1097/DCR.0000000000002259

M3 - Article

C2 - 34856587

SN - 0012-3706

VL - 66

SP - 671

EP - 680

JO - Diseases of the Colon & Rectum

JF - Diseases of the Colon & Rectum

IS - 5

ER -

Meyer VM, Meuzelaar RR, Schoenaker IJH, de Groot J-WB, Reerink O, de Vos Tot Nederveen Cappel WH et al. Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes. Diseases of the Colon & Rectum. 2023;66(5):671-680. Epub 2021 Nov 24. doi: 10.1097/DCR.0000000000002259