National Disparities in Surgical Approach to T1 Rectal Cancer and Impact on Outcomes
This study investigated disparities between patients who had local excision versus radical resection for T1 rectal cancer. A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were
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Veröffentlicht in: | The American surgeon 2016-11, Vol.82 (11), p.1080-1091 |
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creator | Gabriel, Emmanuel Thirunavukarasu, Pragatheeshwar Al-Sukhni, Eisar Attwood, Kristopher Nurkin, Steven J. |
description | This study investigated disparities between patients who had local excision versus radical resection for T1 rectal cancer. A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were |
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A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were <3 cm, well or moderately differentiated without perineural invasion. Patients were stratified based on local excision and radical surgery. The primary outcome was overall survival (OS). Secondary outcomes included 30-day mortality, unplanned readmission rates, and postoperative length of stay. A total of 2235 patients were identified; 1335 (59.7%) underwent local excision and 900 (40.3%) had radical surgery. Overall, radical surgery was associated with an improved 5-year OS rate compared to local excision (0.86 vs 0.78, P = 0.009), increased unplanned readmission (6.5% vs 2.7%, P < 0.001), and longer postoperative length of stay (6.9 days vs 3.1 days, P < 0.001). For patients who had local excision, insurance status was an independent predictor of OS. Compared to patients with private insurance, those with government plans or no insurance had poorer OS (hazard ratio = 1.77 and 17.45, respectively, P = 0.006). Further study is warranted to understand the reasons accounting for this disparity in surgical approach to T1 rectal cancer.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481608201123</identifier><identifier>PMID: 28206935</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Age ; Aged ; Cancer ; Cancer therapies ; Chemotherapy ; Comorbidity ; Demographics ; Endoscopy ; Female ; Humans ; Insurance, Health - statistics & numerical data ; Laparoscopy ; Length of Stay ; Male ; Microsurgery ; Middle Aged ; Mortality ; Multivariate analysis ; Neoplasm Recurrence, Local - epidemiology ; Neoplasm Staging ; Patient Readmission - statistics & numerical data ; Patients ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Retrospective Studies ; Socioeconomic Factors ; Studies ; Surgery ; Survival analysis ; Treatment Outcome ; Tumors ; United States - epidemiology</subject><ispartof>The American surgeon, 2016-11, Vol.82 (11), p.1080-1091</ispartof><rights>2016 Southeastern Surgical Congress</rights><rights>Copyright Southeastern Surgical Congress Nov 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-e6469deda39d6e65a5e8c9d75c6e79bf28811171442cdbd61b68f560d55b79873</citedby><cites>FETCH-LOGICAL-c415t-e6469deda39d6e65a5e8c9d75c6e79bf28811171442cdbd61b68f560d55b79873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/000313481608201123$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/000313481608201123$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28206935$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gabriel, Emmanuel</creatorcontrib><creatorcontrib>Thirunavukarasu, Pragatheeshwar</creatorcontrib><creatorcontrib>Al-Sukhni, Eisar</creatorcontrib><creatorcontrib>Attwood, Kristopher</creatorcontrib><creatorcontrib>Nurkin, Steven J.</creatorcontrib><title>National Disparities in Surgical Approach to T1 Rectal Cancer and Impact on Outcomes</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>This study investigated disparities between patients who had local excision versus radical resection for T1 rectal cancer. A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were <3 cm, well or moderately differentiated without perineural invasion. Patients were stratified based on local excision and radical surgery. The primary outcome was overall survival (OS). Secondary outcomes included 30-day mortality, unplanned readmission rates, and postoperative length of stay. A total of 2235 patients were identified; 1335 (59.7%) underwent local excision and 900 (40.3%) had radical surgery. Overall, radical surgery was associated with an improved 5-year OS rate compared to local excision (0.86 vs 0.78, P = 0.009), increased unplanned readmission (6.5% vs 2.7%, P < 0.001), and longer postoperative length of stay (6.9 days vs 3.1 days, P < 0.001). For patients who had local excision, insurance status was an independent predictor of OS. Compared to patients with private insurance, those with government plans or no insurance had poorer OS (hazard ratio = 1.77 and 17.45, respectively, P = 0.006). Further study is warranted to understand the reasons accounting for this disparity in surgical approach to T1 rectal cancer.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Age</subject><subject>Aged</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Comorbidity</subject><subject>Demographics</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Humans</subject><subject>Insurance, Health - statistics & numerical data</subject><subject>Laparoscopy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Microsurgery</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Neoplasm Staging</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Patients</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Socioeconomic Factors</subject><subject>Studies</subject><subject>Surgery</subject><subject>Survival analysis</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>United States - epidemiology</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp10M9PwyAUB3BiNG5O_wEPhsSLlzpoC4XjMn8mi0t0nhsKdLKspQI9-N9Ls2mMxhPh5fMevC8A5xhdY1wUU4RQhrOcYYpYijBOswMwxoSQhLM0OwTjASSDGIET7zfxmlOCj8EojZ7yjIzB6kkEY1uxhTfGd8KZYLSHpoUvvVsbGeuzrnNWyDcYLFxh-KxliNW5aKV2ULQKPjadkAHaFi77IG2j_Sk4qsXW67P9OQGvd7er-UOyWN4_zmeLROaYhETTnHKllci4opoSQTSTXBVEUl3wqk4Zw3FRnOepVJWiuKKsJhQpQqqCsyKbgKvd3PjD9177UDbGS73dilbb3peYUY44LSiK9PIX3djexb0HRRBlMZEsqnSnpLPeO12XnTONcB8lRuWQefk389h0sR_dV41W3y1fIUcw3QEv1vrHu_-P_AT_5Ibc</recordid><startdate>201611</startdate><enddate>201611</enddate><creator>Gabriel, Emmanuel</creator><creator>Thirunavukarasu, Pragatheeshwar</creator><creator>Al-Sukhni, Eisar</creator><creator>Attwood, Kristopher</creator><creator>Nurkin, Steven J.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>201611</creationdate><title>National Disparities in Surgical Approach to T1 Rectal Cancer and Impact on Outcomes</title><author>Gabriel, Emmanuel ; Thirunavukarasu, Pragatheeshwar ; Al-Sukhni, Eisar ; Attwood, Kristopher ; Nurkin, Steven J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-e6469deda39d6e65a5e8c9d75c6e79bf28811171442cdbd61b68f560d55b79873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Age</topic><topic>Aged</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Comorbidity</topic><topic>Demographics</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Humans</topic><topic>Insurance, Health - statistics & numerical data</topic><topic>Laparoscopy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Microsurgery</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Neoplasm Staging</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Patients</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Socioeconomic Factors</topic><topic>Studies</topic><topic>Surgery</topic><topic>Survival analysis</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gabriel, Emmanuel</creatorcontrib><creatorcontrib>Thirunavukarasu, Pragatheeshwar</creatorcontrib><creatorcontrib>Al-Sukhni, Eisar</creatorcontrib><creatorcontrib>Attwood, Kristopher</creatorcontrib><creatorcontrib>Nurkin, Steven J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gabriel, Emmanuel</au><au>Thirunavukarasu, Pragatheeshwar</au><au>Al-Sukhni, Eisar</au><au>Attwood, Kristopher</au><au>Nurkin, Steven J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National Disparities in Surgical Approach to T1 Rectal Cancer and Impact on Outcomes</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2016-11</date><risdate>2016</risdate><volume>82</volume><issue>11</issue><spage>1080</spage><epage>1091</epage><pages>1080-1091</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>This study investigated disparities between patients who had local excision versus radical resection for T1 rectal cancer. A retrospective analysis was performed using the National Cancer Data Base, 2004 to 2011. Inclusion criteria consisted of patients with T1, N0 rectal adenocarcinoma that were <3 cm, well or moderately differentiated without perineural invasion. Patients were stratified based on local excision and radical surgery. The primary outcome was overall survival (OS). Secondary outcomes included 30-day mortality, unplanned readmission rates, and postoperative length of stay. A total of 2235 patients were identified; 1335 (59.7%) underwent local excision and 900 (40.3%) had radical surgery. Overall, radical surgery was associated with an improved 5-year OS rate compared to local excision (0.86 vs 0.78, P = 0.009), increased unplanned readmission (6.5% vs 2.7%, P < 0.001), and longer postoperative length of stay (6.9 days vs 3.1 days, P < 0.001). For patients who had local excision, insurance status was an independent predictor of OS. Compared to patients with private insurance, those with government plans or no insurance had poorer OS (hazard ratio = 1.77 and 17.45, respectively, P = 0.006). Further study is warranted to understand the reasons accounting for this disparity in surgical approach to T1 rectal cancer.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>28206935</pmid><doi>10.1177/000313481608201123</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Age Aged Cancer Cancer therapies Chemotherapy Comorbidity Demographics Endoscopy Female Humans Insurance, Health - statistics & numerical data Laparoscopy Length of Stay Male Microsurgery Middle Aged Mortality Multivariate analysis Neoplasm Recurrence, Local - epidemiology Neoplasm Staging Patient Readmission - statistics & numerical data Patients Rectal Neoplasms - mortality Rectal Neoplasms - pathology Rectal Neoplasms - surgery Retrospective Studies Socioeconomic Factors Studies Surgery Survival analysis Treatment Outcome Tumors United States - epidemiology |
title | National Disparities in Surgical Approach to T1 Rectal Cancer and Impact on Outcomes |
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