Presentation (CTI)

OBJECTIVES: Locally advanced (Stage II/III) rectal cancer (LARC) management has historically relied on surgery-based approaches. Neoadjuvant strategies including long-course chemoradiotherapy (LCCRT), short-course radiotherapy (SCRT), and total neoadjuvant therapy (TNT), are increasingly used to downstage tumours and support organ preservation. However, many patients still require radical surgery, which is associated with long-term morbidity, stoma formation, reduced quality of life, and substantial healthcare resource use. This analysis estimated the cost burden of surgical interventions for patients with LARC in England.
METHODS: Per-patient costs were estimated across each treatment pathway, including neoadjuvant therapy and surgery (total mesolectal excision [TME]) and stoma care where relevant. A 5-year time horizon was applied, with stoma-related costs accrued for 9 months for temporary stomas and 5 years for permanent stomas. Costs for radiotherapy, surgery, neoadjuvant chemotherapy, and ileostomy reversal were sourced from NHS National Cost Collection data (2024/25), and stoma-management costs from UK published literature. Treatment pathways were defined by radiotherapy type and surgical outcome, using weighted estimates from the National Bowel Cancer Audit 2025 report.
RESULTS: Mean per-patient costs were £32,789 with chemoradiotherapy and £39,850 with TNT. Surgery alone cost £14,712; however, stoma care was a substantial additional cost driver. Over five years, stoma-related costs were £11,762 for temporary and £22,379 for permanent stomas. Estimates were conservative, excluding TME-related complications, treatment toxicities, and wider healthcare utilisation.
CONCLUSIONS: Surgery-based interventions, within a multimodal management approach for stage II/III rectal cancer, are associated with a substantial economic burden. Costs are driven not only by surgery, but also by surgical approach and ongoing stoma care. Therapies that induce deep and durable clinical responses and enable non-operative management may preserve quality of life while reducing the need for extensive rectal surgery and related healthcare resources.