Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1148-1161
Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1148
Contemporary, national patterns of surgery after preoperative therapy for stage II/III rectal adenocarcinoma
Celine Soriano, Henry T Bahnson, Jennifer A Kaplan, Bruce Lin, Ravi Moonka, Huong T Pham, Hagen F Kennecke, Vlad Simianu
Celine Soriano, Jennifer A Kaplan, Ravi Moonka, Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
Henry T Bahnson, Benaroya Research Institute, Seattle, WA 98101, United States
Bruce Lin, Department of Hematology Oncology, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
Huong T Pham, Department of Radiation Oncology, Virginia Mason Franciscan Health, Seattle, WA 98101, United States
Hagen F Kennecke, Department of Medical Oncology, Providence Cancer Instititute, Portland, OR 97213, United States
Vlad Simianu, Section of Colon and Rectal Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA 98101, United States
Author contributions: All authors have made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, been actively involved in drafting the article or making critical revisions related to important intellectual content of the manuscript, and have provided final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Vlad Simianu, FACS, MD, Director, Surgeon, Section of Colon and Rectal Surgery, Department of Surgery, Virginia Mason Medical Center, 1100 Ninth Ave C6-GS, Seattle, WA 98101, United States.
Received: December 29, 2021
Peer-review started: December 29, 2021
First decision: March 13, 2022
Revised: April 11, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: June 15, 2022
Research background

It is not well described whether the contemporary, multi-disciplinary approaches to stage II/III rectal cancer are resulting in meaningful changes in sphincter preservation, surgical quality, or overall survival.

Research motivation

While we push to individualize treatment decisions, it is important to recognize whether contemporary patterns to increase minimally-invasive surgery (MIS) and neoadjuvant treatment offer meaningful change the expected outcome of locally advanced rectal cancer.

Research objectives

Describe broad uptake in sphincter preservation, minimally-invasive approaches to rectal cancer, and the associated surgical outcomes of resection margins, lymph node harvest, and overall survival.

Research methods

Retrospective 'real-world' cohort of National Cancer Database (NCDB) sites, limited to stage II/III surgically treated rectal cancer.

Research results

Neither stage nor neoadjuvant treatment made a meaningful impact on rates of permanent colostomy, which was about 30% across all subgroups. From 2010 to 2016, there was a broad shift to MIS (laparoscopic and robotic) approaches to rectal cancer. These MIS approaches were associated with more frequent negative margins, better lymph node harvest, and improved overall survival after adjustment.

Research conclusions

There has been a shift to MIS approaches to locally advanced rectal cancer. Sphincter preservation rates remain similar in contemporary years, despite increasing neoadjuvant therapy. In recent years, more cases at NCDB sites are done MIS, which associate with better surgical quality and improved overall survival in this study.

Research perspectives

The findings of improved surgical quality and overall survival in this cohort are in contrast to randomized trial data that preceded this study. This may highlight the difference between randomized patients are 'real-world' practices or call into question the need for more contemporary, and pragmatic, trials for locally advanced rectal cancer surgery.