The status of radical proctectomy and sphincter-sparing surgery in the United States

Rocco Ricciardi, Beth A. Virnig, Robert D. Madoff, David A. Rothenberger, Nancy N. Baxter

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1119-1127
Number of pages9
JournalDiseases of the colon and rectum
Volume50
Issue number8
DOIs
StatePublished - Aug 2007

Keywords

  • Abdominoperineal resection
  • Colostomy
  • Nationwide Inpatient Sample
  • Proctectomy
  • Rectal cancer
  • Sphincter

Fingerprint Dive into the research topics of 'The status of radical proctectomy and sphincter-sparing surgery in the United States'. Together they form a unique fingerprint.

Cite this