2023 年 3 月，国家综合癌症网络认可观察并等待那些对总体新辅助治疗具有完全临床反应的患者。新辅助治疗非常有效，因此该建议可能具有广泛的影响，但目前美国器官保存的趋势尚不清楚。描述2006年至2020年美国直肠癌患者的器官保存趋势。这个回顾性观察病例系列包括 2006 年至 2020 年国家癌症数据库中以治疗为目的进行治疗的直肠腺癌成人（年龄≥18 岁）。治疗年份是主要暴露年份。治疗类型为化疗、放疗或手术（直肠切除术、经肛门局部切除术、非肿瘤切除术）。治疗时机分为新辅助或辅助。主要结局是根治性治疗（定义为不进行肿瘤切除、直肠切除或经肛门局部切除的化疗和/或放疗）后每年保留器官的绝对比例。二次分析检查了符合条件的患者的完整病理反应。在纳入的 175545 名患者中，平均 (SD) 年龄为 63 (13) 岁，39.7% 为女性，17.4% 患有临床 I 期疾病，24.7% 患有 IIA 期至 IIA 期。 IIC 期疾病，32.1% 为 IIIA 至 IIIC 期疾病，25.7% 分期未知。器官保存的绝对比例每年增加9.8个百分点（从2006年的18.4%增加到2020年的28.2%；P < .001）。 2006年至2020年，IIA至IIC期疾病患者的器官保存绝对率增加了13.0个百分点（19.5%至32.5%），IIIA至IIC期疾病患者的器官保存绝对率增加了12.9个百分点（16.2%至29.1%） ，未知阶段增加 10.1 个百分点（16.5% 至 26.6%；所有 P < .001）。相反，I期疾病患者的器官保存绝对下降了6.1个百分点（从2006年的26.4%下降到2020年的20.3%；P < .001）。所有阶段的经肛门局部切除年率均有所下降。在 80607 名符合条件的患者亚组中，完全病理缓解的比例从 2006 年的 6.5% 增加到 2020 年的 18.8% (P < .001)。该病例系列表明，直肠癌越来越多地接受药物治疗，特别是在以下患者中：治疗历史上依赖于直肠切除术。鉴于国家综合癌症网络对观察和等待的认可、器官保存的增长趋势以及完全病理反应增加近3倍，国际专业协会应紧急制定多学科核心结果集和护理质量指标，以确保高质量直肠癌研究和护理提供对器官保存的影响。

In March 2023, the National Comprehensive Cancer Network endorsed watch and wait for those with complete clinical response to total neoadjuvant therapy. Neoadjuvant therapy is highly efficacious, so this recommendation may have broad implications, but the current trends in organ preservation in the US are unknown.To describe organ preservation trends among patients with rectal cancer in the US from 2006 to 2020.This retrospective, observational case series included adults (aged ≥18 years) with rectal adenocarcinoma managed with curative intent from 2006 to 2020 in the National Cancer Database.The year of treatment was the primary exposure. The type of therapy was chemotherapy, radiation, or surgery (proctectomy, transanal local excision, no tumor resection). The timing of therapy was classified as neoadjuvant or adjuvant.The primary outcome was the absolute annual proportion of organ preservation after radical treatment, defined as chemotherapy and/or radiation without tumor resection, proctectomy, or transanal local excision. A secondary analysis examined complete pathologic responses among eligible patients.Of the 175 545 patients included, the mean (SD) age was 63 (13) years, 39.7% were female, 17.4% had clinical stage I disease, 24.7% had stage IIA to IIC disease, 32.1% had stage IIIA to IIIC disease, and 25.7% had unknown stage. The absolute annual proportion of organ preservation increased by 9.8 percentage points (from 18.4% in 2006 to 28.2% in 2020; P < .001). From 2006 to 2020, the absolute rate of organ preservation increased by 13.0 percentage points for patients with stage IIA to IIC disease (19.5% to 32.5%), 12.9 percentage points for patients with stage IIIA to IIC disease (16.2% to 29.1%), and 10.1 percentage points for unknown stages (16.5% to 26.6%; all P < .001). Conversely, patients with stage I disease experienced a 6.1-percentage point absolute decline in organ preservation (from 26.4% in 2006 to 20.3% in 2020; P < .001). The annual rate of transanal local excisions decreased for all stages. In the subgroup of 80 607 eligible patients, the proportion of complete pathologic responses increased from 6.5% in 2006 to 18.8% in 2020 (P < .001).This case series shows that rectal cancer is increasingly being managed medically, especially among patients whose treatment historically relied on proctectomy. Given the National Comprehensive Cancer Network endorsement of watch and wait, the increasing trends in organ preservation, and the nearly 3-fold increase in complete pathologic responses, international professional societies should urgently develop multidisciplinary core outcome sets and care quality indicators to ensure high-quality rectal cancer research and care delivery accounting for organ preservation.