The impact of oncological package implementation on the treatment of rectal cancer in years 2013-2019 in Poland – multicenter study

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Purpose: In 2015, in Poland, the oncological package (OP) was established. This law constituted a fast track of oncological diagnosis and treatment and obligatory multidisciplinary team meetings (MDT). The aim of this study was to analyze the impact of OP on rectal cancer treatment. Methods: The study was a multicenter, retrospective analysis of data collected from five centers. It included clinical data of patients operated due to rectal cancer between 2013-2019. For most analyses, patients were categorized into three groups: 2013-2014 – before OP (A), 2015-2016- early development of OP (B), 2017-2019 – further OP functioning (C). Results: A total of 1418 patients were included. In all time intervals, the majority of operations performed were anterior resections. There was a significantly lower local tumor stage (T) observed in subsequent time intervals, while there were no significant differences for N and M. In period C median of resected nodes was significantly higher than in previous periods. Four of the centers showed an increasing tendency in the use of preoperative radiotherapy. The study indicated a significant increase in the use of short-course radiotherapy (SCRT) and a decrease in the number of patients who did not receive any form of preoperative therapy in subsequent periods. In the group that should receive radiotherapy (T3/4 or N+ and M0), the use of SCRT was also significantly increasing. Conclusion: In the whole cohort, there was a significant increase in the use of preoperative radiotherapy and decrease in T stage, changing with the development of OP. Nevertheless, this relation is indirect and more data should be gathered for further conclusions. Trial registration number at ClinicalTrials.gov: NCT04947020 Date of registration: 24 th of June 2021