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

10 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

Fingerprint

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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