Rectal Cancer Surgery and Survival in Asian American, Native Hawaiian, and Pacific Islander Patients

Racial disparities in rectal cancer outcomes are well documented, yet Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often treated as a single group in research, obscuring subgroup differences. We examine variation in sphincter-preserving surgery (SPS)-which avoids a permanent ostomy when oncologically feasible-and survival among AANHPI subgroups.

We conducted a retrospective study using Surveillance, Epidemiology, and End Results data, identifying AANHPI patients with nonmetastatic rectal adenocarcinoma who underwent surgery (2007-2021). Racial subgroups were defined as East Asian, Native Hawaiian and other Pacific Islander (NHPI), Other Asian, South Asian, and Southeast Asian. Logistic regression was used to estimate odds of SPS, and Cox proportional hazards models assessed overall survival.

Among 7989 patients, 87.1% underwent SPS and the 5-year observed overall survival was 81.4%. In fully adjusted models, NHPI patients had 42% lower odds of SPS (odds ratio: 0.58, 95% confidence interval: 0.46-0.74) and a 24% higher risk of mortality from any cause (hazard ratio 1.24, 95% confidence interval 1.04-1.48) compared to East Asian patients. Disparities in both outcomes were most pronounced in NHPI patients in higher-income counties. However, disparities in SPS were worse in NHPI patients with regional disease, compared to disparities in survival, which were worse in NHPI patients with localized disease.

Significant variation exists in rectal cancer treatment and survival across AANHPI subgroups, with NHPI patients facing the most pronounced disparities. These disparities were worse in higher-income counties, highlighting the need for further investigation into structural drivers of disparities affecting NHPI patients.