Impact of Surgical Refusal on Overall Survival in Patients With Rectal Cancer

Background/Aim: While surgery is a major component of treatment for managing rectal cancer, some individuals opt against it, potentially affecting their chances of survival. This study investigated the clinical and demographic elements linked to the decision to refuse surgery and assessed the potential impact of this decision on overall survival (OS). Patients and Methods: We conducted a retrospective cohort study using the U.S. National Cancer Database to analyze factors linked to surgery refusal in patients with rectal cancer. Clinical, demographic and treatment characteristics were compared using Pearson chi-square and Wilcoxon rank-sum tests. Results: Among the 115,066 patients with rectal cancer assessed for surgery, 2,675 individuals (2.3%) declined the procedure. Those who opted out were generally older, with a mean age of 71.9 years, exhibited a higher prevalence of comorbid conditions, and were from racial minority groups or groups with lower socioeconomic status (p<0.001). OS analysis revealed that the cohort who refused surgery demonstrated a lower OS rate, with only 46% surviving for 5 years, in contrast to a 62% 5-year survival rate among those who underwent surgery. Conclusion: Patients with rectal cancer may decline surgical treatment due to factors such as older age, frailty, and socioeconomic challenges. Addressing these obstacles may increase treatment acceptance and potentially lead to improved survival rates.