Current rates, hospital variation and factors associated with optimal surgical resection of rectal cancer in the United States
Lampros Karakozis, Michael Abdelmasseh, Mark Soliman, Matthew Albert, Justin Kelly, John R. T. Monson, Christopher T. AquinaAbstract
Aim
In the era of multidisciplinary cancer care, proctectomy remains an essential procedure in treating rectal cancer. However, the current rates of optimal surgical resection in the US are unknown. This study examined the rates, hospital variation and factors associated with optimal surgical resection.
Methods
Patients with clinically locally advanced (cT3‐T4 and/or cN1‐2) rectal adenocarcinoma who underwent proctectomy between 2021 and 2023 were identified within the National Cancer Database (NCDB). Optimal surgical resection was a composite metric defined as complete total mesorectal excision (TME), negative surgical margins and adequate lymph node yield (LNY) ≥12. Mixed‐effects multivariable analyses were performed to assess the association between optimal surgical resection and overall survival, identify factors associated with optimal surgical resection and assess hospital variation.
Results
Among 6,183 patients, the optimal surgical resection rate was 59.2% (complete TME = 78.6%, negative surgical margins = 85.4%, adequate LNY = 83.7%). Optimal surgical resection was independently associated with longer overall survival (HR = 0.62, 95%CI = 0.48–0.80). Older age ( p < 0.001) and Black race ( p = 0.02) were independently associated with lower odds of achieving optimal surgical resection. There was wide variation in adjusted optimal surgical resection rates across hospitals (range = 30%–82%), and higher hospital volume was associated with optimal surgical resection ( p < 0.001).
Conclusions
Possible disparities in achieving optimal surgical resection were identified among older and Black patients. In addition, there is wide hospital variation in achieving optimal surgical resection along with a direct correlation between higher hospital volume and optimal surgical resection. These findings support selective referral to medium‐to‐high volume centres to achieve better outcomes and future research into the aetiology of these possible disparities.