Sphincter Preservation Surgery in Patients With Rectal Cancer: Does Surgical Subspecialization Matter?

Patients undergoing sphincter-preserving procedures for rectal cancer, such as low anterior resection, have equivalent oncologic outcomes when compared to patients undergoing abdominoperineal resection. 1 Sphincter preservation (SP) has also been shown to result in higher patient satisfaction. 2 Factors associated with lower rates of SP are older age, male sex, higher body mass index (BMI), race, decreased tumor distance from the anal verge (TDAV), lack of neoadjuvant treatment, and low surgeon volume.1,3,4 However, the effect of subspecialization on SP rates has not been well evaluated. Known factors associated with SP (age, sex, BMI, and race) along with statistically significant variables found on univariate analysis (surgeon type, TDAV, and neoadjuvant treatment) were all entered into a multivariate logistic regression model to identify factors independently associated with SP. Variable Patients, No. (%) P value Subspecialist surgeon (n = 106) Non-subspecialist surgeon (n = 74) Age, median (IQR), y 55 (49-59) 54 (49-59) .63 BMI < 18.5 4 (3.8) 1/60 (1.7) a .65 BMI 18.5-24.9 36 (34) 20/60 (33.3) a .90 BMI 25.0-29.9 45 (42.5) 24/60 (40.7) a .94 BMI > 30 21 (19.8) 14/60 (23.3) a .59 Male sex 70 (66) 36 (48.6) .02 Black race 13 (12.3) 1 (1.4) .009 Low lesion (