TY - JOUR
T1 - The status of radical proctectomy and sphincter-sparing surgery in the United States
AU - Ricciardi, Rocco
AU - Virnig, Beth A.
AU - Madoff, Robert D.
AU - Rothenberger, David A.
AU - Baxter, Nancy N.
PY - 2007/8
Y1 - 2007/8
N2 - PURPOSE: Worldwide, "centers of excellence" in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70-90 percent) after proctectomy. The rate of sphincter-sparing surgery with reestablishment of intestinal continuity in the general population of the United Stares is unknown. METHODS: We used data from the Nationwide Inpatient Sample, a 20 percent stratified random sample of patients admitted to hospitals in the United States. We identified patients with rectal cancer from 1988 through 2003 who underwent sphincter-sparing surgery with reestablishment of intestinal continuity or proctectomy with colostomy. To determine predictors of sphincter-sparing surgery with reestablishment of intestinal continuity, we constructed a multivariate model that analyzed patients' age, gender, race, insurance status, and income level. RESULTS: During our 16-year study period, radical extirpative procedures were performed in 41,631 patients: 16,510 (39.7 percent) sphincter-sparing surgery with reestablishment of intestinal continuity, and 25,121 (60.3 percent) sphincter-sacrificing procedures. The proportion of sphincter-sparing procedures increased from 26.9 percent in 1988 to 48.3 percent in 2003 (P < 0.001). There has been no significant change in the rate of sphincter-sparing surgery since 1999 (P = not significant). Logistic regression revealed that patients who were older, male, black, used Medicaid insurance, or lived in lower-income zip codes were less likely to have sphincter-sparing surgery with reestablishment of intestinal continuity (P < 0.001). CONCLUSIONS: Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes.
AB - PURPOSE: Worldwide, "centers of excellence" in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70-90 percent) after proctectomy. The rate of sphincter-sparing surgery with reestablishment of intestinal continuity in the general population of the United Stares is unknown. METHODS: We used data from the Nationwide Inpatient Sample, a 20 percent stratified random sample of patients admitted to hospitals in the United States. We identified patients with rectal cancer from 1988 through 2003 who underwent sphincter-sparing surgery with reestablishment of intestinal continuity or proctectomy with colostomy. To determine predictors of sphincter-sparing surgery with reestablishment of intestinal continuity, we constructed a multivariate model that analyzed patients' age, gender, race, insurance status, and income level. RESULTS: During our 16-year study period, radical extirpative procedures were performed in 41,631 patients: 16,510 (39.7 percent) sphincter-sparing surgery with reestablishment of intestinal continuity, and 25,121 (60.3 percent) sphincter-sacrificing procedures. The proportion of sphincter-sparing procedures increased from 26.9 percent in 1988 to 48.3 percent in 2003 (P < 0.001). There has been no significant change in the rate of sphincter-sparing surgery since 1999 (P = not significant). Logistic regression revealed that patients who were older, male, black, used Medicaid insurance, or lived in lower-income zip codes were less likely to have sphincter-sparing surgery with reestablishment of intestinal continuity (P < 0.001). CONCLUSIONS: Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes.
KW - Abdominoperineal resection
KW - Colostomy
KW - Nationwide Inpatient Sample
KW - Proctectomy
KW - Rectal cancer
KW - Sphincter
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U2 - 10.1007/s10350-007-0250-5
DO - 10.1007/s10350-007-0250-5
M3 - Article
C2 - 17573548
AN - SCOPUS:34447633887
SN - 0012-3706
VL - 50
SP - 1119
EP - 1127
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 8
ER -
