Trends in organ preservation for early-onset rectal cancer: An analysis of the National Cancer Database
Surgical Oncology Insight, 2026
As organ preservation (OP) strategies gain traction in rectal cancer, their adoption specifically in early-onset rectal cancer (EoRC) remains poorly characterized despite potential quality-of-life benefits. In this National Cancer Database study of 12,547 patients under age 50, OP utilization increased significantly from 18.4% in 2014 to 42.7% in 2022 (p<.001), while surgical management declined from 81.6% to 57.3% (p<.001). Compared to patients undergoing surgery, OP patients were more likely to be male (62.4% vs 59.7%, p=.006), Black (9.6% vs 8.2%, p=.011), and uninsured (5.3% vs 4.5%, p<.001). OP patients were more likely to present with cT4 disease (19.2% vs 15.4%, p<.001) but exhibited lower rates of lymphovascular invasion (5.4% vs 12.7%, p<.001) and perineural invasion (4.0% vs 13.2%, p<.001). These findings demonstrate a rapid increase in OP adoption in EoRC and highlight key demographic and tumor-specific factors that may influence treatment selection.
Recommended citation: Shou M, Habib DRS, Ali D, Rogers JL, Wang CC, Sun K, Tosoii JJ, Chang GJ, Fleshman JW, Khan A. Trends in organ preservation for early-onset rectal cancer: An analysis of the National Cancer Database. Surg Oncol Insight. 2026;3(2):100255. doi:10.1016/j.soi.2026.100255