Assessment of Textbook Oncologic Outcomes Following Proctectomy for Rectal Cancer

Area of Science:

• Oncology
• Surgical Outcomes
• Rectal Cancer Research

Background:

• Rectal adenocarcinoma outcomes vary significantly.
• Textbook Oncologic Outcome (TOO) is a composite metric for optimal cancer surgery performance.

Purpose of the Study:

• To evaluate the achievement rate of TOO in rectal adenocarcinoma patients.
• To identify predictors of achieving TOO.
• To explore temporal trends and modifiable factors influencing TOO.

Main Methods:

• Retrospective analysis of Stage II/III rectal adenocarcinoma patients from the National Cancer Database (NCDB).
• TOO defined by negative margins, ≥12 nodes retrieved, no 90-day mortality, and length of stay < 75th percentile.
• Multivariable logistic regression used to identify TOO predictors.

Main Results:

• Of 8869 eligible patients, 44.7% achieved TOO.
• High-volume centers, minimally invasive surgery (MIS), and increasing adoption of MIS correlated with increased TOO achievement over time.
• Predictors of failing TOO included older age, non-private insurance, low-volume centers, open approach, Black race, and higher comorbidity scores.

Conclusions:

• Achieving TOO in rectal adenocarcinoma is currently uncommon.
• Treatment at high-volume centers and adopting MIS are modifiable factors associated with improved TOO.
• TOO achievement is associated with improved patient survival.