Anthony P D’andrea, MD, MPH1, Jani J Lee, MD2, Jordan M Cuevas, BS1, Deepika Bhasin, MPH1, Antoinette Bonaccorso, MD1, Marcher Thompson, MD3, Michael Buckstein, MD3, Randolph M Steinhagen, MD1, Patricia Sylla, MD1. 1Division of Colorectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 2Department of Surgery, Mount Sinai St. Lukes-West, 3Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai
Background: While it has been well-documented recently that the incidence of early onset rectal cancer (EORC) is rising, there is a paucity of data on clinical presentation, treatment course, and specific outcomes.
Methods: A retrospective analysis was performed of a contemporary cohort of rectal cancer patients <50 years of age treated at a large urban tertiary hospital system between 2013 and 2018. Demographics, presentation, treatment and outcomes were evaluated.
Results: 60 patients with EORC were included with 58% males. Average age was 41.3 years (range 25-50), with 17% of patients with BMI ≥30. Presenting symptoms included rectal bleeding (72%), change in bowel habits (10%), rectal (5%) and abdominal pain (5%), and median duration of symptoms was 16 weeks (range 2-250). A family history of colorectal cancer was elicited in 12%, and 3% had documented microsatellite instability. Only 7% of EORC were detected on screening colonoscopy in otherwise asymptomatic patients. Cancer staging was completed within an average of 2 weeks (range 1-12). Tumors were staged I (25%), II (22%), III (42%), IV (12%). Median distance from the anal verge was 6 cm (range 0-13.5). Among 56 (93%) patients staged by pelvic MRI, invasion into the mesorectal fascia was evident in 29% and involvement of the internal or external anal sphincters in 4 patients (7%). Synchronous tumors were present in 11%. Local excision including polypectomy was performed alone in 4 (67%) patients with favorable T1 cancer. Full-course neoadjuvant treatment was administered to 42 patients (70%) including 34 stage II/III, 2 stage I, and 6/7 stage IV patients following good tumor response with chemotherapy. Among 33 patients who underwent post-CRT restaging by MRI, 27.3% demonstrated downstaging. Ultimately, 38/42 (90%) of stage I-IV patients treated with neoadjuvant therapy underwent TME with curative intent. Of the 48 patients who underwent TME, 43 (86%) underwent sphincter preserving surgery and 39 (81%) through a minimally invasive approach that included laparoscopic (41%), robotic (28%), and transanal total mesorectal excision (31%). Conversion to open surgery occurred in 4 cases (10%). Incomplete TME grading was noted in 5.5 % and positive margins in 7%. At a median follow-up of 15 months (range 1-63), local and distant recurrences were 11% and 28% respectively with overall survival of 92.5%.
Conclusion: While this data is limited to a single large urban hospital system, this is the most contemporary series on the demographics, clinical presentation, treatment strategies and short-term outcomes in patients with EORC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95811
Program Number: P311
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster