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 Fac...
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| Veröffentlicht in: | The American surgeon 2023-04, Vol.89 (4), p.1189-1190 |
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| description | 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 ( |
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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 (<5 cm from anal verge) 57/105 (54.3) a 27/71 (38) a .03 Neoadjuvant therapy used 90 (84.9) 59 (79.7) .37 Stage 1 10/104 (9.6) a 8 (10.8) .79 Stage 2 42/104 (40.4) a 22 (29.7) .14 Stage 3 48/104 (46.1) a 32 (43.2) .70 Stage 4 4/104 (3.9) a 8 (10.8) .06 Sphincter-preserving procedure (LAR) 62 (58.5) 31 (41.9) .03 Local recurrence at 3 years 8/98 (8.2) a 4/48 (8.3) a .97 Survival at 3 years 90/98 (91.8) a 45/48 (93.8) .68 Abbreviations: BMI, body mass index; IQR, interquartile range; LAR, low anterior resection. aDenominator differs from n-this represents patients lost to follow up or unavailable data.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/0003134820982563</identifier><identifier>PMID: 33377811</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Abbreviations ; Age ; Body mass index ; Body size ; Cancer ; Colorectal cancer ; Health care access ; Males ; Patient satisfaction ; Patients ; Preservation ; Rectum ; Regression analysis ; Regression models ; Sex ; Sphincter ; Statistical analysis ; Surgeons ; Surgery ; Tumors ; Variables</subject><ispartof>The American surgeon, 2023-04, Vol.89 (4), p.1189-1190</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c318t-c3144a0eab0d324def36cbf7370c3e62d7917d53e7e5b0fcc5178d21aa1806e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0003134820982563$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0003134820982563$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33377811$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Michel-Ruddy, John A.</creatorcontrib><creatorcontrib>Tom, Cynthia M.</creatorcontrib><creatorcontrib>Parrish, Aaron B.</creatorcontrib><creatorcontrib>Kaji, Amy H.</creatorcontrib><creatorcontrib>Chen, Formosa C.</creatorcontrib><creatorcontrib>Petrie, Beverley A.</creatorcontrib><title>Sphincter Preservation Surgery in Patients With Rectal Cancer: Does Surgical Subspecialization Matter?</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>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 (<5 cm from anal verge) 57/105 (54.3) a 27/71 (38) a .03 Neoadjuvant therapy used 90 (84.9) 59 (79.7) .37 Stage 1 10/104 (9.6) a 8 (10.8) .79 Stage 2 42/104 (40.4) a 22 (29.7) .14 Stage 3 48/104 (46.1) a 32 (43.2) .70 Stage 4 4/104 (3.9) a 8 (10.8) .06 Sphincter-preserving procedure (LAR) 62 (58.5) 31 (41.9) .03 Local recurrence at 3 years 8/98 (8.2) a 4/48 (8.3) a .97 Survival at 3 years 90/98 (91.8) a 45/48 (93.8) .68 Abbreviations: BMI, body mass index; IQR, interquartile range; LAR, low anterior resection. aDenominator differs from n-this represents patients lost to follow up or unavailable data.</description><subject>Abbreviations</subject><subject>Age</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Cancer</subject><subject>Colorectal cancer</subject><subject>Health care access</subject><subject>Males</subject><subject>Patient satisfaction</subject><subject>Patients</subject><subject>Preservation</subject><subject>Rectum</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Sex</subject><subject>Sphincter</subject><subject>Statistical analysis</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tumors</subject><subject>Variables</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp1kd9LwzAQx4Mobk7ffZKCL75UkyZpOl9E5k-YOJziY0nT6xbp2pqkwvzrTd1UGPhyx9197pvwPYQOCT4lRIgzjDEllCURHiYRj-kW6hPOeegruo363Tjs5j20Z-2bL1nMyS7qUUqFSAjpo2LazHWlHJhgYsCC-ZBO11Uwbc0MzDLQVTDxHaicDV61mwdPoJwsg5GsFJjz4KoG-w1r5bvTNrMNKC1L_bnSeZDOa1_so51ClhYO1nmAXm6un0d34fjx9n50OQ4VJYnrImMSg8xwTiOWQ0FjlRWCCqwoxFEuhkTknIIAnuFCKU5EkkdESpLgGAQdoJOVbmPq9xasSxfaKihLWUHd2jRigg69K6xDjzfQt7o1lf9dSnEcJ94hwTyFV5QytbUGirQxeiHNMiU47W6Qbt7ArxythdtsAfnvwo_pHghXgJUz-Hv1X8Ev9EGOCg</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Michel-Ruddy, John A.</creator><creator>Tom, Cynthia M.</creator><creator>Parrish, Aaron B.</creator><creator>Kaji, Amy H.</creator><creator>Chen, Formosa C.</creator><creator>Petrie, Beverley A.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20230401</creationdate><title>Sphincter Preservation Surgery in Patients With Rectal Cancer: Does Surgical Subspecialization Matter?</title><author>Michel-Ruddy, John A. ; Tom, Cynthia M. ; Parrish, Aaron B. ; Kaji, Amy H. ; Chen, Formosa C. ; Petrie, Beverley A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c318t-c3144a0eab0d324def36cbf7370c3e62d7917d53e7e5b0fcc5178d21aa1806e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abbreviations</topic><topic>Age</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Cancer</topic><topic>Colorectal cancer</topic><topic>Health care access</topic><topic>Males</topic><topic>Patient satisfaction</topic><topic>Patients</topic><topic>Preservation</topic><topic>Rectum</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Sex</topic><topic>Sphincter</topic><topic>Statistical analysis</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tumors</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Michel-Ruddy, John A.</creatorcontrib><creatorcontrib>Tom, Cynthia M.</creatorcontrib><creatorcontrib>Parrish, Aaron B.</creatorcontrib><creatorcontrib>Kaji, Amy H.</creatorcontrib><creatorcontrib>Chen, Formosa C.</creatorcontrib><creatorcontrib>Petrie, Beverley A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Michel-Ruddy, John A.</au><au>Tom, Cynthia M.</au><au>Parrish, Aaron B.</au><au>Kaji, Amy H.</au><au>Chen, Formosa C.</au><au>Petrie, Beverley A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sphincter Preservation Surgery in Patients With Rectal Cancer: Does Surgical Subspecialization Matter?</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>89</volume><issue>4</issue><spage>1189</spage><epage>1190</epage><pages>1189-1190</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>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 (<5 cm from anal verge) 57/105 (54.3) a 27/71 (38) a .03 Neoadjuvant therapy used 90 (84.9) 59 (79.7) .37 Stage 1 10/104 (9.6) a 8 (10.8) .79 Stage 2 42/104 (40.4) a 22 (29.7) .14 Stage 3 48/104 (46.1) a 32 (43.2) .70 Stage 4 4/104 (3.9) a 8 (10.8) .06 Sphincter-preserving procedure (LAR) 62 (58.5) 31 (41.9) .03 Local recurrence at 3 years 8/98 (8.2) a 4/48 (8.3) a .97 Survival at 3 years 90/98 (91.8) a 45/48 (93.8) .68 Abbreviations: BMI, body mass index; IQR, interquartile range; LAR, low anterior resection. aDenominator differs from n-this represents patients lost to follow up or unavailable data.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>33377811</pmid><doi>10.1177/0003134820982563</doi><tpages>2</tpages></addata></record> |
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| subjects | Abbreviations Age Body mass index Body size Cancer Colorectal cancer Health care access Males Patient satisfaction Patients Preservation Rectum Regression analysis Regression models Sex Sphincter Statistical analysis Surgeons Surgery Tumors Variables |
| title | Sphincter Preservation Surgery in Patients With Rectal Cancer: Does Surgical Subspecialization Matter? |
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