TY - JOUR
T1 - Trends and outcomes of sphincter-preserving surgery for rectal cancer
T2 - a national cancer database study
AU - Shahjehan, Faisal
AU - Kasi, Pashtoon M.
AU - Habermann, Elizabeth
AU - Day, Courtney N.
AU - Colibaseanu, Dorin T.
AU - Mathis, Kellie L.
AU - Larson, David W.
AU - Merchea, Amit
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/2/6
Y1 - 2019/2/6
N2 - Purpose: Previous studies have shown that sphincter-preserving surgery is associated with better quality of life in postsurgical rectal cancer patients. However, the factors predicting the likelihood of undergoing sphincter-preserving surgery have not been well-described. The aim of this study was to report the factors that determined the likelihood of undergoing sphincter-preserving surgery. Methods: Characteristics of 24,018 rectal cancer patients undergoing sphincter-preserving surgery and abdominoperineal resection diagnosed from 2008 to 2012 from the National Cancer Database were investigated retrospectively for rate, pattern, and differences in mortality. Cox proportional hazards models were used to calculate hazard ratios for assessing mortality. Odds ratios were calculated using logistic regressions models for outcome sphincter-preserving surgery. Results: Eighteen thousand four hundred fifty-two (77%) patients had sphincter-preserving surgery. Majority of sphincter-preserving surgery patients were aged < 70 (74%), had private insurance (52%), and got treatment at a comprehensive community cancer program (54%). Multivariable analysis showed that patients with age ≥ 70 (OR 0.87, 95% CI 0.80–0.95), male gender (OR 0.90, 95% CI 0.84–0.96), having Medicare (OR 0.83, 95% CI 0.76–0.90), Medicaid (OR 0.72, 95% CI 0.63–0.81), and poorly differentiated grade (OR 0.78, 95% CI 0.71–0.85) were less likely to undergo sphincter-preserving surgery. Multivariable analysis showed that patients having abdominoperineal resection have higher likelihood of mortality than sphincter-preserving surgery (HR 1.26, 95% CI 1.16–1.36). Conclusions: We were able to identify several patient and tumor-related factors impacting the likelihood of undergoing sphincter-preserving surgery. Patients undergoing non-sphincter sparing surgery had a higher mortality that sphincter preservation.
AB - Purpose: Previous studies have shown that sphincter-preserving surgery is associated with better quality of life in postsurgical rectal cancer patients. However, the factors predicting the likelihood of undergoing sphincter-preserving surgery have not been well-described. The aim of this study was to report the factors that determined the likelihood of undergoing sphincter-preserving surgery. Methods: Characteristics of 24,018 rectal cancer patients undergoing sphincter-preserving surgery and abdominoperineal resection diagnosed from 2008 to 2012 from the National Cancer Database were investigated retrospectively for rate, pattern, and differences in mortality. Cox proportional hazards models were used to calculate hazard ratios for assessing mortality. Odds ratios were calculated using logistic regressions models for outcome sphincter-preserving surgery. Results: Eighteen thousand four hundred fifty-two (77%) patients had sphincter-preserving surgery. Majority of sphincter-preserving surgery patients were aged < 70 (74%), had private insurance (52%), and got treatment at a comprehensive community cancer program (54%). Multivariable analysis showed that patients with age ≥ 70 (OR 0.87, 95% CI 0.80–0.95), male gender (OR 0.90, 95% CI 0.84–0.96), having Medicare (OR 0.83, 95% CI 0.76–0.90), Medicaid (OR 0.72, 95% CI 0.63–0.81), and poorly differentiated grade (OR 0.78, 95% CI 0.71–0.85) were less likely to undergo sphincter-preserving surgery. Multivariable analysis showed that patients having abdominoperineal resection have higher likelihood of mortality than sphincter-preserving surgery (HR 1.26, 95% CI 1.16–1.36). Conclusions: We were able to identify several patient and tumor-related factors impacting the likelihood of undergoing sphincter-preserving surgery. Patients undergoing non-sphincter sparing surgery had a higher mortality that sphincter preservation.
KW - Abdominoperineal resection
KW - NCDB
KW - Rectal cancer
KW - SPS
KW - Sphincter-preserving surgery
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U2 - 10.1007/s00384-018-3171-y
DO - 10.1007/s00384-018-3171-y
M3 - Article
C2 - 30280252
AN - SCOPUS:85054528322
SN - 0179-1958
VL - 34
SP - 239
EP - 245
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
IS - 2
ER -