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. 2025 May;27(5):e70125.
doi: 10.1111/codi.70125.

The impact of nonoperative management of rectal cancer on colon and rectal surgery residents in the United States

Justin T Brady  1 , Jesse P Wright  2 , Jennifer S Davids  3 , Scott R Kelley  4 , Karim Alavi  5 , Sharon L Stein  6 , John R T Monson  7 , Zhaomin Xu  8
Affiliations

The impact of nonoperative management of rectal cancer on colon and rectal surgery residents in the United States

Justin T Brady et al. Colorectal Dis. 2025 May.

Abstract

Aim: There is increasing adoption of nonoperative management of rectal cancer; however, the extent to which trainees are proficient in nonoperative management is unclear. The aim of this work was to describe the exposure of recent colorectal resident graduates to nonoperative management, their comfort level in assessing clinical responses and their comfort in performing rectal cancer surgeries.

Method: This was an online survey of Accreditation Council for Graduate Medical Education-certified colorectal surgery residency graduates of training programmes in 2020, 2021 and 2022 utilizing their respective WhatsApp class chat groups. Data on resident comfort in assessing complete or near complete clinical response as part of nonoperative management, adoption in practice and perceived effects on rectal cancer operative experience were collected.

Results: Forty five graduates responded, with 83.3% exposed to nonoperative management in training. Eighty five per cent utilize nonoperative management in their own practices and 37.1% felt it had a negative impact on preparing them for rectal cancer surgeries. While 82.4% felt comfortable assessing a complete clinical response, only 61.8% felt comfortable assessing a near complete response. Residents who perceived a positive effect on their training felt more comfortable assessing a complete or near complete response.

Conclusion: Most recent graduates were exposed to nonoperative management in training and utilize it in practice, although many did not feel comfortable assessing a near complete response. A significant portion felt it had a negative impact on their experience and quantity of rectal cancer surgeries. This suggests a need to improve colorectal resident education in nonoperative management of rectal cancer while simultaneously preserving surgical experience for trainees.

Keywords: fellowship; nonoperative management; rectal cancer; residency; total neoadjuvant therapy; watch and wait.

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