直肠癌的治疗前景正在迅速发展，特别是随着新辅助疗法的使用越来越多。尽管如此，高达 50% 的 II-III 期疾病患者需要在新辅助治疗后进行手术切除，以达到最佳的肿瘤学结果。然而，许多患者希望避免手术。本研究旨在评估全国和我们机构系统治疗后推荐肿瘤切除率下降的趋势和因素。这是一项回顾性分析，使用 2009 年至 2021 年国家癌症数据库以及 2009 年至 2022 年学术中心的机构队列，包括接受新辅助治疗且适合手术的 I-III 期直肠腺癌成人。在全国 96,997 名患者中，手术率下降从 2009 年的 2.3% 增加到 2021 年的 6.3%，这一趋势反映在我们的 365 名患者机构队列中（2009/2010 年为 0%，2021/2022 年约为 6-12%）。在当地，与接受手术的对照组相比，拒绝手术的患者吸烟率较高，治疗期间暂时失访，并且对新辅助治疗的肿瘤反应更强烈（尽管不完全）。尽管造口是拒绝手术的最常见原因，但拒绝肿瘤切除的患者中有 30.4% 死于造口。我们的研究结果强调了直肠癌新辅助治疗后患者拒绝肿瘤切除的显着趋势。通过揭示选择不手术的患者的结果，我们解决了文献中的一个关键空白，这对于告知患者潜在风险至关重要。© 2024。外科肿瘤学会。

The treatment landscape for rectal cancer is rapidly evolving, particularly with the increasing use of neoadjuvant therapies. Still, up to 50% of patients with stage II-III disease require surgical resection post-neoadjuvant therapy to achieve the best oncologic outcomes. Many patients, however, hope to avoid surgery. This study aimed to assess trends and factors associated with declining recommended oncologic resection after systemic therapy nationally and in our institution.This is a retrospective analysis using the National Cancer Database from 2009 to 2021 and an institutional cohort at an academic center between 2009 and 2022 including adults with stage I-III rectal adenocarcinoma who underwent neoadjuvant therapy and were suitable for surgery.Of 96,997 patients nationally, the rate of declining surgery increased from 2.3% in 2009 to 6.3% in 2021, a trend mirrored in our institutional cohort of 365 patients (0% in 2009/2010 to approximately 6-12% in 2021/2022). Locally, patients who declined surgery had higher rates of tobacco use, temporary loss to follow-up during therapy, and a more robust, albeit incomplete, tumor response to neoadjuvant therapy compared with controls who underwent surgery. Despite a stoma being the most cited reason for declining surgery, 30.4% of patients who declined oncologic resection died with a stoma.Our findings underscore a notable trend of patients declining oncologic resections following neoadjuvant therapy for rectal cancer. By shedding light on the outcomes of patients who opt against surgery, we address a critical gap in the literature essential for informing patients about potential risks.© 2024. Society of Surgical Oncology.