Our Summary

This research paper looks at the outcomes of surgeries for a type of rectal cancer called adenocarcinoma. The researchers created a metric called “textbook oncologic outcome” (TOO) to measure how well these surgeries go. They looked at things like whether the cancer was fully removed, how many lymph nodes were examined, whether the patient died within 90 days, and how long the patient stayed in the hospital.

The researchers studied about 9,000 patients and found that less than half achieved the ideal outcome (TOO). They found that the most common results were successfully removing the cancer, the patient not dying within 90 days, the patient not needing to be readmitted to the hospital, and the patient not having a prolonged hospital stay.

By looking at the data, the researchers found that patients were less likely to achieve the ideal outcome if they were older, had non-private insurance, were treated at a lower-volume hospital, had an open surgery, were of Black race, had a higher Charlson score (a measure of how many other diseases a patient has), or had a specific type of surgery called abdominoperineal resection.

However, the researchers also found that over time, more patients were achieving the ideal outcome, and this was linked to an increase in minimally invasive surgeries. They also found that patients who achieved the ideal outcome tended to survive longer. The researchers suggest that performing surgeries at high-volume centers and using minimally invasive techniques can improve outcomes for rectal adenocarcinoma patients.

FAQs

  1. What is the “textbook oncologic outcome” (TOO) in the context of rectal adenocarcinoma surgery?
  2. What factors were identified as predictors of failure to achieve TOO in patients with rectal adenocarcinoma?
  3. How does the achievement of TOO in rectal adenocarcinoma patients correlate with survival rates?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to consider seeking treatment at a high-volume center and discussing the possibility of a minimally invasive surgery approach. These factors have been associated with improved outcomes and a higher likelihood of achieving optimal clinical performance for cancer surgery. It is important to discuss all treatment options and potential predictors of success with your healthcare provider.

Suitable For

Patients with stage II/III rectal adenocarcinoma who undergo single-agent neoadjuvant chemoradiation and proctectomy within 5-12 weeks are typically recommended for proctectomy. Patients who are younger, have private insurance, are treated at high-volume centers, undergo minimally invasive surgery, and have a lower Charlson score are more likely to achieve optimal clinical performance for cancer surgery. Patients who undergo abdominoperineal resection (APR) and open approach may have a lower likelihood of achieving optimal outcomes. Treatment at high-volume centers and adoption of minimally invasive surgery may improve outcomes for rectal adenocarcinoma patients.

Timeline

Before proctectomy:

  • Patient is diagnosed with stage II/III rectal adenocarcinoma
  • Undergoes single-agent neoadjuvant chemoradiation
  • Preparation for surgery, including pre-operative tests and consultations
  • Surgery scheduled within 5-12 weeks of completion of neoadjuvant therapy

After proctectomy:

  • Recovery period in the hospital, typically a few days to a week
  • Post-operative care, including pain management and monitoring for complications
  • Follow-up appointments with healthcare providers to monitor recovery and address any issues
  • Adjuvant therapy may be recommended depending on the stage and characteristics of the cancer
  • Long-term surveillance for recurrence and monitoring of overall health and well-being.

What to Ask Your Doctor

  1. What is a proctectomy and why is it necessary for my condition?
  2. What are the potential risks and complications associated with a proctectomy?
  3. What is the expected recovery time following a proctectomy?
  4. Will I need any additional treatments or therapies after the surgery?
  5. How will a proctectomy affect my quality of life, including bowel function and sexual function?
  6. What is the success rate of this surgery in terms of removing the cancer and preventing recurrence?
  7. Are there any alternative treatment options to consider before proceeding with a proctectomy?
  8. How many of these procedures have you performed and what is your success rate?
  9. Will I need to make any lifestyle or dietary changes following the surgery?
  10. What follow-up care will be required after the proctectomy?

Reference

Authors: Naffouje SA, Ali MA, Kamarajah SK, White B, Salti GI, Dahdaleh F. Journal: J Gastrointest Surg. 2022 Jun;26(6):1286-1297. doi: 10.1007/s11605-021-05213-9. Epub 2022 Apr 19. PMID: 35441331