Why Some Rectal Cancer Patients Avoid Surgery

Surgery has long been the main treatment for rectal cancer. But in some cases, doctors now use a “watch-and-wait” or nonoperative management (NOM) approach. This means patients receive treatments like chemotherapy and radiation first, and if the tumor disappears completely, surgery may be avoided.
A large study looked at more than 128,000 patients with rectal cancer to understand who receives this non-surgical approach. Researchers found that about 10% of patients were treated without surgery.
Several factors influenced whether patients received NOM. Older patients, those with certain tumor characteristics, and people treated at community hospitals were more likely to receive this approach. Social factors also played a role, including race, insurance coverage, and geographic location.
The study also found differences in survival among patients treated without surgery. Outcomes were better when patients received both radiation therapy and chemotherapy, and when care was delivered at experienced centers.

These findings highlight that treatment decisions are influenced not only by the cancer itself but also by social and healthcare access factors. As nonoperative treatment becomes more common, doctors hope to ensure that all patients have equal access to the best treatment options.