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Rectal resection following neoadjuvant therapy in a Midwest community hospital setting: The case for standardization over centralization as the means to optimize rectal cancer outcomes in the United States

Published:September 10, 2018DOI:https://doi.org/10.1016/j.amjsurg.2018.09.001

      Highlights

      • Rectal resection outcomes similar among high volume surgeons, despite setting.
      • Morbidity and mortality similar among high volume surgeons, despite hospital setting.
      • Overall and disease-free survival similar among high volume surgeons, despite setting.

      Abstract

      Background

      Incomplete and flawed national databases reveal strikingly inferior outcomes for rectal cancer patients resected at “low” versus “high “ volume hospitals, therefore, a study of outcomes of a “high” volume surgeon in a “low” volume Midwest community hospital setting examined this perception in comparison to contemporary studies.

      Methods

      Review of 109 consecutive patients who underwent open resection of rectal cancer following neoadjuvant therapy, 1999–2010.

      Results

      Despite the majority of tumors in the low rectum (54%), the rate of abdominoperineal resection was only 39% with R0 resection achieved in 94% and primary anastomosis in 61/109 patients (56%). Disease-free survival (DFS) 73%: stage 0 (complete response)- 100%, stage I- 88%, stage II- 68%, stage III- 50%, stage IV- 0% with recurrence rate of 11% (local recurrence (LR) - 3%, distant - 8%).

      Conclusion

      Outcomes of rectal cancer resection by a “high” volume surgeon in a “low” volume Midwest community hospital setting were comparable to contemporary studies from tertiary care institutions. Geographic location and hospital capacity matter less than access to multispecialty expertise providing neoadjuvant therapy and following standard principles of oncologic resection, in efforts to optimize rectal cancer outcomes.

      Keywords

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