Abstract
e15658 Background: Rectal cancer is a common and potentially debilitating form of gastrointestinal cancer. Despite advances in surgical and systemic therapies, a significant proportion of patients present with locally advanced or recurrent disease. Interventional radiology (IR) has emerged as a crucial tool in the management of rectal cancer, offering a number of minimally invasive treatments aimed at locally destroying the tumor. This study aims to evaluate the efficacy and prognostic significance of combining IR treatments with polypectomy or excisional biopsy in the management of rectal cancer, compared to polypectomy or excisional biopsy alone. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary rectal cancer from the cecum to the sigmoid (primary site codes C209), including the appendix, diagnosed between 2000-2019. Patients were included if management of the primary tumor included either excisional biopsy, polypectomy, or local tumor destruction (LTD) via photodynamic therapy, electrocautery, cryosurgery, or laser ablation (surgical codes 21-24). Variables included for statistical analyses were age at diagnosis, sex, race, stage, and surgical management subtype status. Results: A total of 24309 patients were collected from this search of which 1437 patients were selected that had undergone a combination polypectomy or excisional biopsy with LTD, 15005 patients underwent polypectomy alone, 7481 patients underwent excisional biopsy alone, 386 patients underwent curette and fulguration. On Kaplan-Meier, combination treatment showed a worse mean survival than polypectomy alone (p < 0.01). Combination treatment showed better mean survival than excisional biopsy alone ( < 0.001). The combination treatment showed similar survivability to curette and fulguration. The one-, three-, and five-year survival rates of combination treatment were 98.5%, 95.8%, and 94.8%, respectively, which is significantly greater than excisional biopsy at all points but significantly worse than polypectomy alone at all time points (p’s < 0.001). On Cox regression, combination treatment showed no difference in survival to polypectomy alone and curette fulguration. Combination treatment survival was significantly better than excisional biopsy alone (p < 0.001). Additionally, older age (p < 0.001), regional spread of tumor (p < 0.001), and distant spread of tumor (p < 0.0001) were all associated with worse survival outcomes. Conclusions: Combination polypectomy or excisional biopsy with IR LTD procedures are associated with improved survival compared to excisional biopsy alone for the treatment of rectal cancer. Our findings suggest that IR procedures may serve as an effective adjunct treatment option for primary rectal tumor management.