Related Experiment Video
Updated: Aug 17, 2025
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Use of a national registry to define a composite quality metric for rectal cancer
Celsa M Tonelli1, Sujay Kulshrestha2, Marc Singer2
1Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA. Electronic address: https://twitter.com/celsatonelli.
Background:
Quality assessment in oncologic surgery has traditionally involved reporting discrete metrics that may be difficult for patients and referring providers to interpret. We define a composite quality metric (CQM) for resection in rectal cancer.
Methods:
We queried the National Cancer Database to identify patients undergoing low anterior resection for clinical stage II-III rectal adenocarcinoma between 2010 and 2017. CQM was defined as appropriate neoadjuvant therapy, margin-negative resection, appropriate lymph node assessment, postoperative length of stay (LOS) < 75th percentile, and no 30-day readmission or mortality.
Results:
19,721 patients met inclusion criteria; 8,083 (41%) had a CQM. The most common reasons for failure to achieve CQM: inadequate node assessment (27%), prolonged LOS (26%). On Cox modeling, CQM (aHR 0.70, 95% CI [0.66, 0.75]) was associated with improved overall survival.
Conclusion:
CQM is independently associated with improved survival in rectal cancer and may be an effective measure of quality.
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