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01-08-2007 | Original Contributions

The Status of Radical Proctectomy and Sphincter-Sparing Surgery in the United States

Authors: Rocco Ricciardi, M.D., M.P.H., Beth A. Virnig, Ph.D., M.P.H., Robert D. Madoff, M.D., David A. Rothenberger, M.D., Nancy N. Baxter, M.D., Ph.D.

Published in: Diseases of the Colon & Rectum | Issue 8/2007

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.

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Title: The Status of Radical Proctectomy and Sphincter-Sparing Surgery in the United States
Authors: Rocco Ricciardi, M.D., M.P.H.
Beth A. Virnig, Ph.D., M.P.H.
Robert D. Madoff, M.D.
David A. Rothenberger, M.D.
Nancy N. Baxter, M.D., Ph.D.
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 8/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-007-0250-5

2024 ASCO Annual Meeting

Springer Medicine

The Status of Radical Proctectomy and Sphincter-Sparing Surgery in the United States

Purpose

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Purpose

Methods

Results

Conclusions

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