PURPOSE: Worldwide, "centers of excellence" in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70-90 percent) after proctectomy. The rate of sphincter-sparing surgery with reestablishment of intestinal continuity in the general population of the United Stares is unknown. METHODS: We used data from the Nationwide Inpatient Sample, a 20 percent stratified random sample of patients admitted to hospitals in the United States. We identified patients with rectal cancer from 1988 through 2003 who underwent sphincter-sparing surgery with reestablishment of intestinal continuity or proctectomy with colostomy. To determine predictors of sphincter-sparing surgery with reestablishment of intestinal continuity, we constructed a multivariate model that analyzed patients' age, gender, race, insurance status, and income level. RESULTS: During our 16-year study period, radical extirpative procedures were performed in 41,631 patients: 16,510 (39.7 percent) sphincter-sparing surgery with reestablishment of intestinal continuity, and 25,121 (60.3 percent) sphincter-sacrificing procedures. The proportion of sphincter-sparing procedures increased from 26.9 percent in 1988 to 48.3 percent in 2003 (P < 0.001). There has been no significant change in the rate of sphincter-sparing surgery since 1999 (P = not significant). Logistic regression revealed that patients who were older, male, black, used Medicaid insurance, or lived in lower-income zip codes were less likely to have sphincter-sparing surgery with reestablishment of intestinal continuity (P < 0.001). CONCLUSIONS: Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes.
PURPOSE: Worldwide, "centers of excellence" in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70-90 percent) after proctectomy. The rate of sphincter-sparing surgery with reestablishment of intestinal continuity in the general population of the United Stares is unknown. METHODS: We used data from the Nationwide Inpatient Sample, a 20 percent stratified random sample of patients admitted to hospitals in the United States. We identified patients with rectal cancer from 1988 through 2003 who underwent sphincter-sparing surgery with reestablishment of intestinal continuity or proctectomy with colostomy. To determine predictors of sphincter-sparing surgery with reestablishment of intestinal continuity, we constructed a multivariate model that analyzed patients' age, gender, race, insurance status, and income level. RESULTS: During our 16-year study period, radical extirpative procedures were performed in 41,631 patients: 16,510 (39.7 percent) sphincter-sparing surgery with reestablishment of intestinal continuity, and 25,121 (60.3 percent) sphincter-sacrificing procedures. The proportion of sphincter-sparing procedures increased from 26.9 percent in 1988 to 48.3 percent in 2003 (P < 0.001). There has been no significant change in the rate of sphincter-sparing surgery since 1999 (P = not significant). Logistic regression revealed that patients who were older, male, black, used Medicaid insurance, or lived in lower-income zip codes were less likely to have sphincter-sparing surgery with reestablishment of intestinal continuity (P < 0.001). CONCLUSIONS: Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes.
Authors: Reilly P Musselman; Tara Gomes; Deanna M Rothwell; Rebecca C Auer; Husein Moloo; Robin P Boushey; Carl van Walraven Journal: J Gastrointest Surg Date: 2018-12-03 Impact factor: 3.452
Authors: Jason Park; Heather B Neuman; Antonia V Bennett; Lily Polskin; P Terry Phang; W Douglas Wong; Larissa K Temple Journal: Dis Colon Rectum Date: 2014-02 Impact factor: 4.585
Authors: Christopher M Dodgion; Bridget A Neville; Stuart R Lipsitz; Deborah Schrag; Elizabeth Breen; Michael J Zinner; Caprice C Greenberg Journal: J Surg Res Date: 2014-03-22 Impact factor: 2.192
Authors: Roman A Inglin; Daniel Eberli; Lukas E Brügger; Tullio Sulser; Norman S Williams; Daniel Candinas Journal: Int J Colorectal Dis Date: 2014-11-19 Impact factor: 2.571
Authors: Jeong-Heum Baek; Abdulhadi Alrubaie; Eduardo A Guzman; Sun Keun Choi; Casandra Anderson; Steven Mills; Joseph Carmichael; Andy Dagis; Dajun Qian; Joseph Kim; Julio Garcia-Aguilar; Michael J Stamos; Lisa Bening; Alessio Pigazzi Journal: Int J Colorectal Dis Date: 2012-07-29 Impact factor: 2.571