Oncological Outcomes and Hospital Costs of the Treatment in Rectal Cancer Patients: Watch-And-Wait Policy and Standard Surgical Treatment

BACKGROUND: Little is known about the costs of the current treatment strategy in locally advanced rectal cancer, in which patients with a clinical complete response after chemoradiotherapy are treated in a watch-and-wait-policy. OBJECTIVE: The aim of this study is to present the oncological outcome and hospital costs of patients with a complete response after chemoradiotherapy (watch-and-wait-policy) and patients with an incomplete response after chemoradiotherapy (total mesorectal excision). DESIGN: This was a cohort study. SETTINGS: Academic and non-academic hospital. PATIENTS: Patients with locally advanced rectal cancer received either a watch-and-wait-policy or TME depending on their clinical response to chemoradiotherapy. INTERVENTIONS: Watch-and-wait-policy, total mesorectal excision MAIN OUTCOME MEASURES:: Overall-, local recurrence free-, distant metastasis free survival and hospital costs over a two years follow-up period. RESULTS: A total of 292 patients with locally advanced rectal cancer were included. Mean age was 65.1 years and 64.7% were men. 105 patients were included in the watch-and-wait subgroup, and 187 in the total mesorectal excision subgroup. Both subgroups showed good oncological outcomes. Hospital costs consisted of five categories: costs of primary surgery; costs of adjuvant chemotherapy; costs of examinations; costs of additional surgery; and costs of treatment of regrowth/metastasis. The mean costs per patient were O6.713 (watch-and-wait subgroup) and O17.108 (total mesorectal excision subgroup) over the first two years. LIMITATIONS: Only costs from a hospital perspective, follow-up was two years, partly retrospective study, no comparative study. CONCLUSIONS: Overall survival was good in both subgroups and comparable to literature. The mean costs per patient differ between the watch-and-wait subgroup (O6.713) and the total mesorectal excision subgroup (O17.108). No comparison between the groups could be made. Based on the results of this study, the current strategy, where patient with a clinical complete response are treated in a watch-and-wait policy, and patients with an incomplete response were treated with total mesorectal excision, is likely to be (cost)saving. See Video Abstract at http://links.lww.com/DCR/B177.