Advertisement

International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 239–245 | Cite as

Trends and outcomes of sphincter-preserving surgery for rectal cancer: a national cancer database study

  • Faisal Shahjehan
  • Pashtoon M. Kasi
  • Elizabeth Habermann
  • Courtney N. Day
  • Dorin T. Colibaseanu
  • Kellie L. Mathis
  • David W. Larson
  • Amit MercheaEmail author
Original Article

Abstract

Purpose

Previous studies have shown that sphincter-preserving surgery is associated with better quality of life in postsurgical rectal cancer patients. However, the factors predicting the likelihood of undergoing sphincter-preserving surgery have not been well-described. The aim of this study was to report the factors that determined the likelihood of undergoing sphincter-preserving surgery.

Methods

Characteristics of 24,018 rectal cancer patients undergoing sphincter-preserving surgery and abdominoperineal resection diagnosed from 2008 to 2012 from the National Cancer Database were investigated retrospectively for rate, pattern, and differences in mortality. Cox proportional hazards models were used to calculate hazard ratios for assessing mortality. Odds ratios were calculated using logistic regressions models for outcome sphincter-preserving surgery.

Results

Eighteen thousand four hundred fifty-two (77%) patients had sphincter-preserving surgery. Majority of sphincter-preserving surgery patients were aged < 70 (74%), had private insurance (52%), and got treatment at a comprehensive community cancer program (54%). Multivariable analysis showed that patients with age ≥ 70 (OR 0.87, 95% CI 0.80–0.95), male gender (OR 0.90, 95% CI 0.84–0.96), having Medicare (OR 0.83, 95% CI 0.76–0.90), Medicaid (OR 0.72, 95% CI 0.63–0.81), and poorly differentiated grade (OR 0.78, 95% CI 0.71–0.85) were less likely to undergo sphincter-preserving surgery. Multivariable analysis showed that patients having abdominoperineal resection have higher likelihood of mortality than sphincter-preserving surgery (HR 1.26, 95% CI 1.16–1.36).

Conclusions

We were able to identify several patient and tumor-related factors impacting the likelihood of undergoing sphincter-preserving surgery. Patients undergoing non-sphincter sparing surgery had a higher mortality that sphincter preservation.

Keywords

Sphincter-preserving surgery SPS Rectal cancer NCDB Abdominoperineal resection 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD et al (2013) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 56(5):535–550CrossRefGoogle Scholar
  2. 2.
    Dimitriou N, Michail O, Moris D, Griniatsos J (2015) Low rectal cancer: sphincter preserving techniques-selection of patients, techniques and outcomes. World J Gastrointest Oncol 7(7):55–70CrossRefGoogle Scholar
  3. 3.
    Bordeianou L, Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM (2014) Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results. J Gastrointest Surg 18(7):1358–1372CrossRefGoogle Scholar
  4. 4.
    Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D (2008) Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene? Gut 57(12):1690–1697CrossRefGoogle Scholar
  5. 5.
    Dodgion CM, Neville BA, Lipsitz SR, Schrag D, Breen E, Zinner MJ, Greenberg CC (2014) Hospital variation in sphincter preservation for elderly rectal cancer patients. J Surg Res 191(1):161–168CrossRefGoogle Scholar
  6. 6.
    Abdelsattar ZM, Wong SL, Birkmeyer NJ, Cleary RK, Times ML, Figg RE, Peters N, Krell RW, Campbell DA, Russell MM, Hendren S (2014) Multi-institutional assessment of sphincter preservation for rectal cancer. Ann Surg Oncol 21(13):4075–4080CrossRefGoogle Scholar
  7. 7.
    Mohammed S, Anaya DA, Awad SS, Albo D, Berger DH, Artinyan A (2015) Sphincter preservation rates after radical resection for rectal cancer in the United States veteran population: opportunity for improvement in early disease. Ann Surg Oncol 22(1):216–223CrossRefGoogle Scholar
  8. 8.
    Temple LK, Romanus D, Niland J, Veer AT, Weiser MR, Skibber J, Wilson J, Rajput A, Benson A, Wong YN, Schrag D (2009) Factors associated with sphincter-preserving surgery for rectal cancer at national comprehensive cancer network centers. Ann Surg 250(2):260–267CrossRefGoogle Scholar
  9. 9.
    Richardson DP, Porter GA, Johnson PM (2013) Population-based use of sphincter-preserving surgery in patients with rectal cancer: is there room for improvement? Dis Colon Rectum 56(6):704–710CrossRefGoogle Scholar
  10. 10.
    Ricciardi R, Roberts PL, Read TE, Marcello PW, Schoetz DJ, Baxter NN (2010) Variability in reconstructive procedures following rectal cancer surgery in the United States. Dis Colon Rectum 53(6):874–880CrossRefGoogle Scholar
  11. 11.
    Engel AF, Oomen JL, Eijsbouts QA, Cuesta MA, van de Velde CJ (2003) Nationwide decline in annual numbers of abdomino-perineal resections: effect of a successful national trial? Colorectal Dis 5(2):180–184Google Scholar
  12. 12.
    Marwan K, Staples MP, Thursfield V, Bell SW (2010) The rate of abdominoperineal resections for rectal cancer in the state of Victoria, Australia: a population-based study. Dis Colon Rectum 53(12):1645–1651CrossRefGoogle Scholar
  13. 13.
    Tilney HS, Heriot AG, Purkayastha S, Antoniou A, Aylin P, Darzi AW, Tekkis PP (2008) A national perspective on the decline of abdominoperineal resection for rectal cancer. Ann Surg 247(1):77–84CrossRefGoogle Scholar
  14. 14.
    Ricciardi R, Virnig BA, Madoff RD, Rothenberger DA, Baxter NN (2007) The status of radical proctectomy and sphincter-sparing surgery in the United States. Dis Colon Rectum 50(8):1119–1127 discussion 26-7 CrossRefGoogle Scholar
  15. 15.
    Archampong D, Borowski D, Wille-Jorgensen P, Iversen LH. (2012) Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev (3):Cd005391Google Scholar
  16. 16.
    Porter GA, Soskolne CL, Yakimets WW, Newman SC (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227(2):157–167CrossRefGoogle Scholar
  17. 17.
    Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, et al. (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg, 230(3):404–11; discussion 11–3Google Scholar
  18. 18.
    Dorrance HR, Docherty GM, O’Dwyer PJ (2000) Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery. Dis Colon Rectum 43(4):492–498CrossRefGoogle Scholar
  19. 19.
    (ACS) ACoS. National Accreditation Program for Rectal Cancer (NAPRC) [Available from: https://www.facs.org/quality-programs/cancer/naprc
  20. 20.
    (ACS) ACoS. National Cancer Database (NCDB) [Available from: https://www.facs.org/quality%20programs/cancer/ncdb

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Hematology and OncologyMayo ClinicJacksonvilleUSA
  2. 2.Division of Colon and Rectal SurgeryMayo ClinicJacksonvilleUSA
  3. 3.The Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  4. 4.Department of Health Science ResearchMayo ClinicRochesterUSA
  5. 5.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA

Personalised recommendations