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Horesh N, Emile SH, Freund MR, Garoufalia Z, Gefen R, Nagarajan A, Wexner SD. Local excision vs. proctectomy in patients with ypT0-1 rectal cancer following neoadjuvant therapy: a propensity score matched analysis of the National Cancer Database. Tech Coloproctol 2024; 28:128. [PMID: 39305380 PMCID: PMC11416410 DOI: 10.1007/s10151-024-02994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 08/05/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND We aimed to evaluate outcomes of organ preservation by local excision (LE) compared to proctectomy following neoadjuvant therapy for rectal cancer. METHODS This retrospective observational study using the National Cancer Database (NCDB) included patients with locally advanced non-metastatic rectal cancer (ypT0-1 tumors) treated with neoadjuvant therapy between 2004 and 2019. Outcomes of patients who underwent LE or proctectomy were compared. 1:1 propensity score matching including patient demographics, clinical and therapeutic factors was used to minimize selection bias. Main outcome was overall survival (OS). RESULTS 11,256 of 318,548 patients were included, 526 (4.6%) of whom underwent LE. After matching, mean 5-year OS was similar between the groups (54.1 vs. 54.2 months; p = 0.881). Positive resection margins (1.2% vs. 0.6%; p = 0.45), pathologic T stage (p = 0.07), 30-day mortality (0.6% vs. 0.6%; p = 1), and 90-day mortality (1.5% vs. 1.2%; p = 0.75) were comparable between the groups. Length of stay (1 vs. 6 days; p < 0.001) and 30-day readmission rate (5.3% vs. 10.3%; p = 0.02) were lower in LE patients. Multivariate analysis of predictors of OS demonstrated male sex (HR 1.38, 95% CI 1.08-1.77; p = 0.009), higher Charlson score (HR 1.52, 95% CI 1.29-1.79; p < 0.001), poorly differentiated carcinoma (HR 1.61, 95% CI 1.08-2.39; p = 0.02), mucinous carcinoma (HR 3.53, 95% CI 1.72-7.24; p < 0.001), and pathological T1 (HR 1.45, 95% CI 1.14-1.84; p = 0.002) were independent predictors of increased mortality. LE did not correlate with worse OS (HR 0.91, 95% CI 0.42-1.97; p = 0.82). CONCLUSION Our findings show no overall significant survival difference between LE and total mesorectal excision, including ypT1 tumors. Moreover, patients with poorly differentiated or mucinous adenocarcinomas generally had poorer outcomes, regardless of surgical method.
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Affiliation(s)
- N Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - S H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of General Surgery Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Z Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - R Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - A Nagarajan
- Department of Hematology/Oncology, Cleveland Clinic Florida, Weston, FL, USA
| | - S D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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Emile SH, Garoufalia Z, Dourado J, Salama E, Wexner SD. Predictors and outcomes of delays between diagnosis and definitive surgery for rectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108618. [PMID: 39208691 DOI: 10.1016/j.ejso.2024.108618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/13/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The National Accreditation Program for Rectal Cancer (NAPRC) recommends definitive treatment of rectal cancer commence within 60 days from diagnosis. This study aimed to assess predictors of >60 days delay between diagnosis and definitive surgery of rectal cancer and the impact on survival and short-term outcomes. METHODS Retrospective cohort analysis of patients with stage I-III rectal adenocarcinoma who underwent proctectomy without preoperative neoadjuvant treatment from the National Cancer Database (2015-2019). Based on the time interval between diagnosis and definitive surgery, patients were divided into timely non-adherent (>60 days) and timely-adherent (≤60 days) groups. Multivariate analysis determined predictors of delayed definitive surgery. RESULTS 9479 patients (57.5 % males; mean age: 63.7 years) had a 41-day median time between diagnosis and definitive surgery. Non-adherence was noted in 27.9 % of patients. Independent predictors of non-adherence were male sex (Odds ratio [OR]: 1.25; p < 0.001), Black (OR: 1.65; p < 0.001) or Asian (OR: 1.33; p = 0.014) race, Charlson score 2 (OR: 1.33; p = 0.005) or 3 (OR: 1.55; p < 0.001), urban residence (OR: 1.21; p = 0.003), abdominoperineal resection (OR: 1.69; p < 0.001), pelvic exenteration (OR: 1.7; p = 0.002), and robotic-assisted surgery (OR: 1.22; p = 0.001). Medicare (OR: 0.725; p = 0.003) and private insurance (OR: 0.711; p < 0.001) were associated with better adherence. 30-day and 90-day mortality, unplanned readmission, and overall survival were similar. CONCLUSIONS Male Black or Asian patients with high Charlson scores, and undergoing abdominoperineal resection, pelvic exenteration, and robotic-assisted surgery were more likely non-adherent with NAPRC standards with >60 days delay before definitive surgery for rectal cancer. Hopefully, recognition for these reasons for delay of definitive surgery will lead to an improvement in adherence to the standards.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Ebram Salama
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
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Arndt KR, Dombek GE, Allar BG, Storino A, Fleishman A, Quinn J, Fabrizio A, Cataldo TE, Messaris E. Impact of National Accreditation Program for Rectal Cancer guidelines on surgical margin status. Surg Oncol 2023; 51:101921. [PMID: 36898906 DOI: 10.1016/j.suronc.2023.101921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The American College of Surgeons established the National Accreditation Program for Rectal Cancer (NAPRC) to standardize rectal cancer care. We sought to assess the impact of NAPRC guidelines at a tertiary care center on surgical margin status. MATERIALS AND METHODS The Institutional NSQIP database was queried for patients with rectal adenocarcinoma undergoing surgery for curative intent two years prior to and following implementation of NAPRC guidelines. Primary outcome was surgical margin status before (pre-NAPRC) versus after (post-NAPRC) implementation of NAPRC guidelines. RESULTS Surgical pathology in five (5%) pre-NAPRC and seven (8%) post-NAPRC patients had positive radial margins (p = 0.59); distal margins were positive in three (3%) post-NAPRC and six (7%) post-NAPRC patients (p = 0.37). Local recurrence was observed in seven (6%) pre-NAPRC patients, there were no recurrences to date in post-NAPRC patients (p = 0.15). Metastasis was observed in 18 (17%) pre-NAPRC patients and four (4%) post-NAPRC patients (p = 0.55). CONCLUSION NAPRC implementation was not associated with a change in surgical margin status for rectal cancer at our institution. However, the NAPRC guidelines formalize evidence-based rectal cancer care and we anticipate that improvements will be greatest in low-volume hospitals which may not utilize multidisciplinary collaboration.
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Affiliation(s)
- Kevin R Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Gabrielle E Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeanne Quinn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas E Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Soriano CR, Evans E, Lin BS, Kaplan JA, Post AB, Bahnson HT, Simianu VV. Where are Colorectal Resections being Performed? Colon and Rectal Cancer Operations in Washington State are Decentralized. J Gastrointest Surg 2023; 27:2583-2585. [PMID: 37430095 DOI: 10.1007/s11605-023-05776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Celine R Soriano
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ethan Evans
- Benaroya Research Institute, Seattle, WA, USA
| | - Bruce S Lin
- Department of Hematology-Oncology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Amber B Post
- Department of Radiation Oncology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | | | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
- Virginia Mason Medical Center, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA.
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Carpenter EL, Adams AM, McCarthy PM, Chick RC, Spitzer HV, Nelson DW, Clifton GT, Bowen DK, Krell RW, Vreeland TJ. Meeting the New Commission on Cancer Operative Standards: Where Do We Stand Now? Mil Med 2023; 188:e1558-e1562. [PMID: 36111895 DOI: 10.1093/milmed/usac274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The 2020 Commission on Cancer accreditation standards 5.7 and 5.8 address total mesorectal excision for rectal cancer and lymph node sampling for lung cancer. The purpose of this review was to assess our institution's compliance with these operative standards, which will be required in 2022 and 2023, and provide recommendations to other military training facilities seeking to comply with these standards. MATERIALS AND METHODS A 2018-2020 single institution chart review was performed of operative and pathology reports. Identified deficits were addressed in meetings with colorectal and thoracic surgery leadership, and cases were followed to reassess compliance. RESULTS A total of 12 rectal and 48 lung cancer cases met the inclusion criteria and were examined. Pre-intervention compliance for standards 5.7 and 5.8 was 58% and 35%, respectively, because of inadequate synoptic reporting and lymph node sampling. After intervention, compliance was 100%. CONCLUSIONS Our institution requires changes to comply with new standards, including in areas of documentation and systematic pulmonary lymph node sampling. We provide lessons learned from our own institutional experience, including practical tips and recommendations to achieve compliance. All military training facilities performing lung and rectal oncologic resections should conduct an internal review of applicable cases in preparation for upcoming American College of Surgeons Commission on Cancer site visits.
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Affiliation(s)
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
| | - Patrick M McCarthy
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
| | - Robert C Chick
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
| | - Holly V Spitzer
- Department of Surgery, William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, 5005 N Piedras St, El Paso, TX 79920, USA
| | - Guy T Clifton
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
| | - Donnell K Bowen
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
| | - Robert W Krell
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
| | - Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, San Antonio TC, TX 78234, USA
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Russell TA, Ko C. History and Role of Quality Accreditation. Clin Colon Rectal Surg 2023; 36:279-284. [PMID: 37223226 PMCID: PMC10202542 DOI: 10.1055/s-0043-1761592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Accreditation has played a major role in the evolution of health care quality as well as the structure and organization of American medicine. In its earliest iterations, accreditation aimed to set a minimum standard of care, and now more prominently sets standards for high quality, optimal patient care. There are several institutions that provide accreditations that are relevant to colorectal surgery including the American College of Surgeons (ACS) Commission on Cancer, National Cancer Institute Cancer Center Designation, National Accreditation Program for Rectal Cancer, and the ACS Geriatrics Verification Program. While each program has unique criteria, the aim of accreditation is to assure high-quality evidenced-based care. In addition to these benchmarks, these programs provide avenues for collaboration and research between centers and programs.
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Affiliation(s)
- Tara A. Russell
- Division of Colorectal Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Clifford Ko
- Division of Colorectal Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, California
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Jayaprakasam VS, Alvarez J, Omer DM, Gollub MJ, Smith JJ, Petkovska I. Watch-and-Wait Approach to Rectal Cancer: The Role of Imaging. Radiology 2023; 307:e221529. [PMID: 36880951 PMCID: PMC10068893 DOI: 10.1148/radiol.221529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 03/08/2023]
Abstract
The diagnosis and treatment of rectal cancer have evolved dramatically over the past several decades. At the same time, its incidence has increased in younger populations. This review will inform the reader of advances in both diagnosis and treatment. These advances have led to the watch-and-wait approach, otherwise known as nonsurgical management. This review briefly outlines changes in medical and surgical treatment, advances in MRI technology and interpretation, and landmark studies or trials that have led to this exciting juncture. Herein, the authors delve into current state-of-the-art methods to assess response to treatment with MRI and endoscopy. Currently, these methods for avoiding surgery can be used to detect a complete clinical response in as many as 50% of patients with rectal cancer. Finally, the limitations of imaging and endoscopy and future challenges will be discussed.
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Janet Alvarez
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Dana M. Omer
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Marc J. Gollub
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - J. Joshua Smith
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
| | - Iva Petkovska
- From the Departments of Radiology (V.S.J., M.J.G., I.P.) and Surgery
(J.A., D.M.O., J.J.S.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave,
Box 29, New York, NY 10065
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Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. Surg Oncol 2022; 40:101708. [PMID: 35092916 DOI: 10.1016/j.suronc.2022.101708] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
The safety of colorectal surgery for oncological disease is steadily improving, but anastomotic leakage is still the most feared and devastating complication from both a surgical and oncological point of view. Anastomotic leakage affects the outcome of the surgery, increases the times and costs of hospitalization, and worsens the prognosis in terms of short- and long-term outcomes. Anastomotic leakage has a wide range of clinical features ranging from radiological only finding to peritonitis and sepsis with multi-organ failure. C-reactive protein and procalcitonin have been identified as early predictors of anastomotic leakage starting from postoperative day 2-3, but abdominal-pelvic computed tomography scan is still the gold standard for the diagnosis. Several treatments can be adopted for anastomotic leakage. However, there is not a universally accepted flowchart for the management, which should be individualized based on patient's general condition, anastomotic defect size and location, indication for primary resection and presence of the proximal stoma. Non-operative management is usually preferred in patients who underwent proximal faecal diversion at the initial operation. Laparoscopy can be attempted after minimal invasive surgery and can reduce surgical stress in patients allowing a definitive treatment. Reoperation for sepsis control is rarely necessary in those patients who already have a diverting stoma at the time of the leak, especially in extraperitoneal anastomoses. In patients without a stoma who do not require abdominal reoperation for a contained pelvic leak, there are several treatment options, including laparoscopic diverting ileostomy combined with trans-anal anastomotic tube drainage, percutaneous drainage or recently developed endoscopic procedures, such as stent or clip placement or endoluminal vacuum-assisted therapy. We describe the current approaches to treat this complication, as well as the clinical tests necessary to diagnose and provide an effective therapy.
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Affiliation(s)
| | - Pietro Fransvea
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Cariati
- Department of Surgery, General Surgery Unit, "San Giovanni di Dio" Hospital, Crotone, Italy
| | - Neill James Adams
- Department of Health Sciences, Clinical Microbiology Unit, "Magna Grecia" University, Catanzaro, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe Brisinda
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
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Lin M, O'Guinn M, Zipprer E, Hsieh JC, Dardon AT, Raman S, Foglia CM, Chao SY. Impact of Medicaid Expansion on the Diagnosis, Treatment, and Outcomes of Stage II and III Rectal Cancer Patients. J Am Coll Surg 2022; 234:54-63. [PMID: 35213460 DOI: 10.1097/xcs.0000000000000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Insurance status has been associated with disparities in stage at cancer diagnosis. We examined how Medicaid expansion (ME) impacted diagnoses, surgical treatment, use of neoadjuvant therapies (NCRT), and outcomes for Stage II and III rectal cancer. STUDY DESIGN We used 2010-2017 American College of Surgeons National Cancer Database (NCDB) to identify patients ages 18-65, with Medicaid as primary form of payment, and were diagnosed with Stage II or III rectal cancer. Patients were stratified based on Census bureau division's ME adoption rates of High, Medium, Low. Overall trends were examined, and patient characteristics and outcomes were compared before and after ME date of 1/1/2014. RESULTS Over 8 years of NCDB data examined, there was an increasing trend of Stage II and III rectal cancer diagnoses, surgical resection, and use of NCRT for Medicaid patients. We observed an increase in age, proportion of White Medicaid patients in Low ME divisions, and proportion of fourth income quartile patients in High ME divisions. Univariate analysis showed decreased use of open surgery for all 3 categories after ME, but adjusted odds ratios (aOR) were not significant based on multivariate analysis. NCRT utilization increased after ME for all 3 ME adoption categories and aOR significantly increased for Low and High ME divisions. ME significantly decreased 90-day mortality. CONCLUSIONS Medicaid expansion had important impacts on increasing Stage II and III rectal cancer diagnoses, use of NCRT, and decreased 90-day mortality for patients with Medicaid. Our study supports increasing health insurance coverage to improve Medicaid patient outcomes in rectal cancer care.
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Affiliation(s)
- Mayin Lin
- From the MercyOne Des Moines Surgical Group (Lin, Raman), Des Moines, IA
- the Department of Surgery, Creighton University, Omaha, NE (Lin, Raman)
| | - Makayla O'Guinn
- the General Surgery Residency Program, MercyOne Des Moines Medical Center (O'Guinn, Zipprer), Des Moines, IA
| | - Elizabeth Zipprer
- the General Surgery Residency Program, MercyOne Des Moines Medical Center (O'Guinn, Zipprer), Des Moines, IA
| | - John C Hsieh
- the Department of Animal Science, Iowa State University, Ames, IA (Hsieh)
| | - Arturo Torices Dardon
- the General Surgery Residency Program, NewYork-Presbyterian/Queens, Flushing, NY (Dardon)
| | - Shankar Raman
- From the MercyOne Des Moines Surgical Group (Lin, Raman), Des Moines, IA
- the Department of Surgery, Creighton University, Omaha, NE (Lin, Raman)
| | - Christopher M Foglia
- the Department of Surgery, NewYork-Presbyterian/Queens, Weill Cornell Medicine, Flushing, NY (Foglia, Chao)
| | - Steven Y Chao
- the Department of Surgery, NewYork-Presbyterian/Queens, Weill Cornell Medicine, Flushing, NY (Foglia, Chao)
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Bajpai S, Wood L, Cannon JA, Chu DI, Hollis RH, Gunnells DJ, Hardiman KM, Kennedy GD, Morris MS. Multidisciplinary clinics for colorectal cancer may not provide more efficient coordination of care. Am J Surg 2021; 223:1167-1171. [PMID: 34895698 DOI: 10.1016/j.amjsurg.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This retrospective study compares a multidisciplinary clinic (MDC) to standard care for time to treatment of colorectal cancer. METHODS We queried our institutional ACS-NSQIP database for patients undergoing surgery for colorectal cancer from 2017 to 2020. Patients were stratified by initial clinic visit (MDC vs control). Primary endpoint was the time to start treatment (TST), either neoadjuvant therapy or surgery, from the date of diagnosis by colonoscopy. RESULTS A total of 405 patients were evaluated (115 MDC, 290 Control). TST from diagnosis was not significantly shorter for the MDC cohort (MDC 30 days, Control 37 days; p = 0.07) even when stratified by type of initial treatment of neoadjuvant therapy (MDC 30, Control 34 days; p = 0.28) or surgery (MDC 32.5 days, Control 38 days; p = 0.35). CONCLUSION Implementation of an MDC provides insignificant reduction in delay to start treatment for colorectal cancer patients as compared to standard care colorectal surgery clinics. CLASSIFICATION Colorectal.
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Affiliation(s)
- Swara Bajpai
- Department of Surgery, University of Alabama at Birmingham, AL, USA.
| | - Lauren Wood
- Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Jamie A Cannon
- Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Daniel I Chu
- Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Robert H Hollis
- Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Drew J Gunnells
- Department of Surgery, University of Alabama at Birmingham, AL, USA
| | - Karin M Hardiman
- Department of Surgery, University of Alabama at Birmingham, AL, USA
| | | | - Melanie S Morris
- Department of Surgery, University of Alabama at Birmingham, AL, USA
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