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Assessment of Textbook Oncologic Outcomes Following Proctectomy for Rectal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Outcomes of rectal adenocarcinoma vary considerably. Composite “textbook oncologic outcome” (TOO) is a single metric that estimates optimal clinical performance for cancer surgery.

Methods

Patients with stage II/III rectal adenocarcinoma who underwent single-agent neoadjuvant chemoradiation and proctectomy within 5–12 weeks were identified in the National Cancer Database (NCDB). TOO was defined as achievement of negative distal and circumferential resection margin (CRM), retrieval of ≥ 12 nodes, no 90-day mortality, and length of stay (LOS) < 75th percentile of corresponding year’s range. Multivariable logistic regression was used to identify predictors of TOO.

Results

Among 318,225 patients, 8869 met selection criteria. Median age was 62 years (IQR 54–71), and 5550 (62.6%) were males. Low anterior resection was the most common procedure (LAR, 6,037 (68.1%) and 3084 (34.8%) were treated at a high-volume center (≥ 20 rectal resections/year). TOO was achieved in 3967 patients (44.7%). Several components of TOO were achieved commonly, including negative CRM (87.4%), no 90-day mortality (98.0%), no readmission (93.0%), and no prolonged hospitalization (78.8%). Logistic regression identified increasing age, non-private insurance, low-volume centers, open approach, Black race, Charlson score ≥ 3, and abdominoperineal resection (APR) as predictors of failure to achieve TOO. Over time, TOOs were attained more commonly which correlated with increased minimally invasive surgery (MIS) adoption. TOO achievement was associated with improved survival.

Conclusions

Rectal adenocarcinoma patients achieve TOO uncommonly. Treatment at high-volume centers and MIS approach were among modifiable factors associated with TOO in this study.

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Authors and Affiliations

  1. Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Samer A. Naffouje

  2. Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK

    Muhammed A. Ali & Sivesh K. Kamarajah

  3. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Bradley White & George I. Salti

  4. Department of Surgical Oncology, Edward-Elmhurst Health, 120 Spalding Drive, Ste 205, Naperville, IL, 60540, USA

    George I. Salti & Fadi Dahdaleh

Authors
  1. Samer A. Naffouje
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  2. Muhammed A. Ali
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  3. Sivesh K. Kamarajah
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  4. Bradley White
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  5. George I. Salti
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  6. Fadi Dahdaleh
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Contributions

Study concepts: FD, SN.

Study design: SN, FD, SK.

Manuscript preparation: FD, SN.

Data acquisition: SN, FD.

Quality control of data algorithm: SK, GS, BW, MA.

Manuscript review: SN, FD, SK, GS.

Corresponding author

Correspondence to Fadi Dahdaleh.

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Conflict of Interest

The authors declare no competing interests.

Synopsis

Textbook outcomes of rectal adenocarcinoma in NCDB are achieved uncommonly. MIS and volume are modifiable factors.

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Naffouje, S.A., Ali, M.A., Kamarajah, S.K. et al. Assessment of Textbook Oncologic Outcomes Following Proctectomy for Rectal Cancer. J Gastrointest Surg 26, 1286–1297 (2022). https://doi.org/10.1007/s11605-021-05213-9

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