Hospital variation in sphincter preservation for elderly rectal cancer patients

566 Background: Rates of sphincter preserving surgery (SPS) have been proposed as a quality measure for rectal cancer (RC) surgery. However, administrative and registry-based SPS rates often lack critical patient and tumor characteristics, rendering it unclear if variations in SPS rates are due to unmeasured case-mix differences or selection criteria. The aim of this study was to determine whether hospitals’ SPS rates differ after accounting for clinical characteristics. Methods: As part of a RC quality project, 10 hospitals in the Michigan Surgical Quality Collaborative retrospectively collected RC-specific data from 2007-2012. We assessed for SPS predictors using multivariable regression. Patients were categorized as “definitely SPS eligible” a priori if they did not have any of the following: poor sphincter control, stoma preference, sphincter involvement, tumor <6 cm from the anal verge (an intentionally conservative cutoff) or metastatic disease. We compared hospital performance with and without these clinical data using Spearman’s correlations. Results: In total, 349 patients underwent surgery for RC in 10 hospitals (5/10 high volume and 6/10 major teaching). Of those, 74% had SPS (range by hospital 50%-91%). On multivariable analysis, only pre-op radiation, tumor location, hospital teaching status and hospital ID were independent predictors of SPS, but not age, sex, BMI, AJCC stage, ASA class, or hospital CRC surgery volume. Analyses of the “definitely eligible” patients revealed an overall SPS rate of 88% (65-100%). Hospital SPS rankings using crude versus clinically-adjusted SPS rates proved to be highly correlated (Spearman’s ρ= 0.9). Tumor locations suggest differing selection criteria for SPS in different hospitals (Table). Conclusions: Rates of SPS vary by hospital, even after correcting for clinical characteristics using detailed chart review. These data suggest missed opportunities for SPS, and refute the general hypothesis that hospital variation in SPS rates in previous studies is due to unmeasured case-mix differences. [Table: see text]

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Is Preoperative Chemoradiotherapy Beneficial for Sphincter Preservation in Low-Lying Rectal Cancer Patients?

Medicine ◽

10.1097/md.0000000000003463 ◽

2016 ◽

Vol 95 (18) ◽

pp. e3463 ◽

Cited By ~ 3

Author(s):

In Ja Park ◽

Chang Sik Yu ◽

Seok-Byung Lim ◽

Jong Lyul Lee ◽

Chan Wook Kim ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Preoperative Chemoradiotherapy ◽

Sphincter Preservation

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Sphincter preservation after preoperative chemoradation on 247 T3 rectal cancer patients: Analysis in four consecutive phase II studies

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.07.094 ◽

2004 ◽

Vol 60 (1) ◽

pp. S296-S297 ◽

Cited By ~ 1

Author(s):

M. Gambacorta ◽

V. Valentini ◽

C. Coco ◽

G. Doglietto ◽

M. Cosimelli ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Phase Ii ◽

Sphincter Preservation ◽

Phase Ii Studies ◽

T3 Rectal Cancer ◽

Consecutive Phase

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The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy

Radiation Oncology ◽

10.1186/s13014-021-01746-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Qiao-xuan Wang ◽

Rong Zhang ◽

Wei-wei Xiao ◽

Shu Zhang ◽

Ming-biao Wei ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Surgical Resection ◽

Neoadjuvant Chemoradiotherapy ◽

Radical Resection ◽

Complete Response ◽

Sphincter Preservation ◽

Watch And Wait ◽

Free Survival ◽

Clinical Complete Response

Abstract Background The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancer patients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection. Methods Stage II/III rectal adenocarcinoma patients who received neoadjuvant chemoradiotherapy and achieved a cCR were selected from the databases of three centers. cCR was evaluated by findings from digital rectal examination, colonoscopy, and radiographic images. Patients in whom the watch-and-wait strategy was adopted were matched with patients who underwent radical resection through 1:1 propensity score matching analyses. Survival was calculated and compared in the two groups using the Kaplan–Meier method with the log rank test. Results A total of 117 patients in whom the watch-and-wait strategy was adopted were matched with 354 patients who underwent radical resection. After matching, there were 94 patients in each group, and no significant differences in term of age, sex, T stage, N stage or tumor location were observed between the two groups. The median follow-up time was 38.2 months. Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable. Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group. Conclusion The watch-and-wait strategy was safe, with similar survival outcomes but a superior sphincter preservation rate as compared to surgery in rectal cancer patients achieving a cCR after neoadjuvant chemoradiotherapy, and could be offered as a promising conservative alternative to invasive radical surgery.

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