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.
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Sponsored by the Clinical Scholars Research Grant from the Academic Health Center, University of Minnesota, Minneapolis, Minnesota.
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Ricciardi, R., Virnig, B.A., Madoff, R.D. et al. The Status of Radical Proctectomy and Sphincter-Sparing Surgery in the United States. Dis Colon Rectum 50, 1119–1127 (2007). https://doi.org/10.1007/s10350-007-0250-5
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DOI: https://doi.org/10.1007/s10350-007-0250-5