Sphincter Preservation Rates After Radical Resection for Rectal Cancer in the United States Veteran Population: Opportunity for Improvement in Early Disease

Somala Mohammed, Daniel A. Anaya, Samir S. Awad, Daniel Albo, David H. Berger, Avo Artinyan

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Sphincter preservation (SP) is an important goal of rectal cancer surgery. We hypothesized that SP rates among veteran patients have increased and are comparable to national rates, and that a subset of patients with early disease still undergo non-SP procedures.

Methods: Patients with nonmetastatic primary rectal adenocarcinoma who underwent curative-intent rectal resection were identified from the Veterans Affairs Central Cancer Registry (VACCR) database (1995–2010). SP trends over time were described and compared to the Surveillance, Epidemiology, and End-Results (SEER) population. Subset analysis was performed in patients with nonirradiated, pathologic stage 0–I rectal cancers, a population that may qualify for novel SP strategies.

Results: Of 5,145 study patients, 3,509 (68 %) underwent SP surgery. The VACCR SP rate increased from 59.9 % in 1995–1999 to 79.3 % in 2005–2010, when it exceeded that of SEER (76.9 %, p = 0.023). On multivariate analysis, recent time period was independently associated with higher likelihood of SP (odds ratio [OR] 2.64, p < 0.001). Preoperative radiotherapy (OR 0.51, p < 0.001) and higher pathologic stage (OR 0.37, stage III, p < 0.001) were negative predictors. In patients with nonirradiated pathologic stage 0–I cancers, SP rates also increased, but 25 % of these patients underwent non-SP procedures. Within this subset, patients with clinical stage 0 and I disease still had significant rates of abdominoperineal resection (7.7 and 17.0 %, respectively).

Conclusions: SP rates among veterans have increased and surpass national rates. However, an unacceptable proportion of patients with stage 0–I rectal cancers still undergo non-SP procedures. Multimodal treatment with local excision may further improve SP rates in this subset of patients.

Original languageEnglish (US)
Pages (from-to)216-223
Number of pages8
JournalAnnals of Surgical Oncology
Volume22
Issue number1
DOIs
StatePublished - Jan 2015
Externally publishedYes

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Veterans
Rectal Neoplasms
Population
Odds Ratio
Registries
Epidemiology
Combined Modality Therapy
Neoplasms
Adenocarcinoma
Radiotherapy
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Sphincter Preservation Rates After Radical Resection for Rectal Cancer in the United States Veteran Population : Opportunity for Improvement in Early Disease. / Mohammed, Somala; Anaya, Daniel A.; Awad, Samir S.; Albo, Daniel; Berger, David H.; Artinyan, Avo.

In: Annals of Surgical Oncology, Vol. 22, No. 1, 01.2015, p. 216-223.

Research output: Contribution to journalArticle

Mohammed, Somala ; Anaya, Daniel A. ; Awad, Samir S. ; Albo, Daniel ; Berger, David H. ; Artinyan, Avo. / Sphincter Preservation Rates After Radical Resection for Rectal Cancer in the United States Veteran Population : Opportunity for Improvement in Early Disease. In: Annals of Surgical Oncology. 2015 ; Vol. 22, No. 1. pp. 216-223.
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abstract = "Background: Sphincter preservation (SP) is an important goal of rectal cancer surgery. We hypothesized that SP rates among veteran patients have increased and are comparable to national rates, and that a subset of patients with early disease still undergo non-SP procedures.Methods: Patients with nonmetastatic primary rectal adenocarcinoma who underwent curative-intent rectal resection were identified from the Veterans Affairs Central Cancer Registry (VACCR) database (1995–2010). SP trends over time were described and compared to the Surveillance, Epidemiology, and End-Results (SEER) population. Subset analysis was performed in patients with nonirradiated, pathologic stage 0–I rectal cancers, a population that may qualify for novel SP strategies.Results: Of 5,145 study patients, 3,509 (68 {\%}) underwent SP surgery. The VACCR SP rate increased from 59.9 {\%} in 1995–1999 to 79.3 {\%} in 2005–2010, when it exceeded that of SEER (76.9 {\%}, p = 0.023). On multivariate analysis, recent time period was independently associated with higher likelihood of SP (odds ratio [OR] 2.64, p < 0.001). Preoperative radiotherapy (OR 0.51, p < 0.001) and higher pathologic stage (OR 0.37, stage III, p < 0.001) were negative predictors. In patients with nonirradiated pathologic stage 0–I cancers, SP rates also increased, but 25 {\%} of these patients underwent non-SP procedures. Within this subset, patients with clinical stage 0 and I disease still had significant rates of abdominoperineal resection (7.7 and 17.0 {\%}, respectively).Conclusions: SP rates among veterans have increased and surpass national rates. However, an unacceptable proportion of patients with stage 0–I rectal cancers still undergo non-SP procedures. Multimodal treatment with local excision may further improve SP rates in this subset of patients.",
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T2 - Opportunity for Improvement in Early Disease

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AU - Berger, David H.

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AB - Background: Sphincter preservation (SP) is an important goal of rectal cancer surgery. We hypothesized that SP rates among veteran patients have increased and are comparable to national rates, and that a subset of patients with early disease still undergo non-SP procedures.Methods: Patients with nonmetastatic primary rectal adenocarcinoma who underwent curative-intent rectal resection were identified from the Veterans Affairs Central Cancer Registry (VACCR) database (1995–2010). SP trends over time were described and compared to the Surveillance, Epidemiology, and End-Results (SEER) population. Subset analysis was performed in patients with nonirradiated, pathologic stage 0–I rectal cancers, a population that may qualify for novel SP strategies.Results: Of 5,145 study patients, 3,509 (68 %) underwent SP surgery. The VACCR SP rate increased from 59.9 % in 1995–1999 to 79.3 % in 2005–2010, when it exceeded that of SEER (76.9 %, p = 0.023). On multivariate analysis, recent time period was independently associated with higher likelihood of SP (odds ratio [OR] 2.64, p < 0.001). Preoperative radiotherapy (OR 0.51, p < 0.001) and higher pathologic stage (OR 0.37, stage III, p < 0.001) were negative predictors. In patients with nonirradiated pathologic stage 0–I cancers, SP rates also increased, but 25 % of these patients underwent non-SP procedures. Within this subset, patients with clinical stage 0 and I disease still had significant rates of abdominoperineal resection (7.7 and 17.0 %, respectively).Conclusions: SP rates among veterans have increased and surpass national rates. However, an unacceptable proportion of patients with stage 0–I rectal cancers still undergo non-SP procedures. Multimodal treatment with local excision may further improve SP rates in this subset of patients.

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