Organ Preservation in Rectal Adenocarcinoma—A Growing Practice With Promise and Pitfalls
Menée à partir de données portant sur 101 001 patients atteints d'un cancer du rectum (âge médian : 60 ans), cette étude de cohorte rétrospective analyse l'évolution du recours à la surveillance active en fonction de l'âge sur la période 2006-2023
In his 2013 New Yorker article “Slow Ideas,” Atul Gawande compared the rapid adoption of ether anesthesia, first demonstrated in 1846 and spreading to become standard practice in the US and Britain within approximately 7 years, with the slow uptake of antiseptic technique, published in 1867 but still halting in adoption 2 decades later. In this schema, organ preservation for rectal adenocarcinoma that achieves a complete clinical response to neoadjuvant therapy, also known as nonoperative management or watch and wait, appears to have transitioned from a slow idea to a fast one over the past decade. As Keeling et al demonstrate in their study using the 2006 to 2023 National Cancer Database (NCDB), use of organ preservation in the US for stage II and III rectal adenocarcinoma, which was first described by Habr-Gama et al in 2004, remained low for a decade but began accelerating in 2014 and accelerated further in 2019. Even though organ preservation was not formally incorporated into the National Comprehensive Cancer Network guidelines until 2018, use of nonoperative management increased by approximately 10% per year in 2015 to 2018 and by a staggering 22% per year in 2019 to 2023. Rates of nonoperative management, stable at approximately 13% in 2006 to 2013, had increased to approximately 45% in 2023. The large increase was attributable to the widespread adoption of organ preservation as an intentional treatment strategy.
JAMA Network Open , commentaire, 2026