Long-Term Survival After Surgical Resection for Rectal Cancer Is Associated With Textbook Outcome but Not Surgical...

Area of Science:

• Oncology
• Surgical Quality Improvement
• Public Health

Background:

• Rectal cancer surgery is complex, with outcomes varying significantly by institution.
• Prior research suggests higher hospital case volume correlates with better survival for rectal cancer patients.
• Textbook Outcome (TO) is a quality metric representing an ideal result after complex cancer surgery.

Purpose of the Study:

• To analyze the association between achieving Textbook Outcome (TO) after rectal cancer resection and long-term survival.
• To compare the impact of TO on survival versus hospital case volume alone.

Main Methods:

• Retrospective analysis of 48,484 rectal adenocarcinoma patients (2014-2015) from the National Cancer Database.
• Hospitals categorized into low (LV), medium (MV), and high-volume (HV) strata based on quartile cutoffs.
• TO defined by: adequate lymph node count (≥12), R0 resection, short length of stay, no 30-day adverse events, and timely systemic therapy.
• Hierarchical multivariable Cox regression used for adjusted long-term survival analyses.

Main Results:

• Textbook Outcome (TO) was achieved in only 28.5% of patients.
• Patients treated at high-volume (HV) hospitals were more likely to achieve TO (31.2%) compared to medium (MV, 29.6%) and low-volume (LV, 23.2%) hospitals.
• Achieving TO was associated with significantly improved 5-year survival (84.0% vs. 72.0%).
• On multivariable analysis, TO was the strongest protective factor against mortality (HR 0.60), independent of hospital volume.

Conclusions:

• Only 28.5% of patients undergoing rectal cancer resection achieve Textbook Outcome (TO).
• Achieving TO confers a 40% reduction in long-term mortality, irrespective of hospital surgical case volume.
• Optimizing long-term survival for rectal cancer patients should prioritize meeting TO criteria over solely increasing surgical case volume.