Survival after Abdominoperineal and Sphincter-Preserving Resection in Nonmetastatic Rectal Cancer: A Population-Based Time-Trend and Propensity Score-Matched SEER Analysis

Abstract

Background. Abdominoperineal resection (APR) has been associated with impaired survival in nonmetastatic rectal cancer patients. It is unclear whether this adverse outcome is due to the surgical procedure itself or is a consequence of tumor-related characteristics. Study Design. Patients were identified from the Surveillance, Epidemiology, and End Results database. The impact of APR compared to coloanal anastomosis (CAA) on survival was assessed by Cox regression and propensity-score matching. Results. In 36,488 patients with rectal cancer resection, the APR rate declined from 31.8% in 1998 to 19.2% in 2011, with a significant trend change in 2004 at 21.6% (P < 0.001). To minimize a potential time-trend bias, survival analysis was limited to patients diagnosed after 2004. APR was associated with an increased risk of cancer-specific mortality after unadjusted analysis (HR = 1.61, 95% CI: 1.28–2.03, P < 0.01) and multivariable adjustment (HR = 1.39, 95% CI: 1.10–1.76, P < 0.01). After optimal adjustment of highly biased patient characteristics by propensity-score matching, APR was not identified as a risk factor for cancer-specific mortality (HR = 0.85, 95% CI: 0.56–1.29, P = 0.456). Conclusions. The current propensity score-adjusted analysis provides evidence that worse oncological outcomes in patients undergoing APR compared to CAA are caused by different patient characteristics and not by the surgical procedure itself.

Influence of Body Mass Index on Long-Term Outcome in Patients with Rectal Cancer—A Single Centre Experience

“…These findings are concordant to a study on 1598 patients with low and mid rectal cancer treated in 38 hospitals being part of the Spanish Rectal Cancer Project [18]. One possible hypothesis is that different patient characteristics, rather than the surgical procedure (APE) itself, cause a difference in oncological outcome in patients undergoing APE [19].…”

Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

“…for CAA (p < .001). 17 However, results were associated more with different, disadvantageous patient characteristics than the surgical procedure itself. From five European randomized rectal cancer trials, APR was associated with an increased risk of CRM involvement (OR 2.52, p < .001), increased local recurrence rate (hazard ratio [HR] 1.53, p = .001) and decreased cancer-specific survival rate (HR 1.31, p = .002).…”

“…15 Even a highlyspecialized center reported an APR rate of 25% for all rectal cancers between 2009 and 2015. 16 This rate remained stable as MRI-based staging, total neoadjuvant therapy and MIS increased.In a SEER analysis, the APR rate decreased from 31.8% in to19.2% in 2011 17. Between 2005 and 2015, the APR rate in Germany was 29% 18.…”

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

“…Total mesorectal excision (TME) with sphincter preservation is increasingly offered for rectal cancer resection . However, a distal rectal anastomosis is accompanied by significant risk of leakage associated with increased morbidity and mortality and adverse oncological outcomes .…”