title: Population-based use of sphincter-preserving surgery in patients with rectal cancer: is there room for improvement?
abstract: BACKGROUND
  Treatment of rectal cancer in North America has been associated with lower rates of sphincter-preserving surgery in comparison with other regions. It is unclear if these lower rates are due to patient, tumor, or treatment factors; thus, the potential to increase the use of sphincter-preserving surgery is unknown.
  
  
  OBJECTIVE
  The aim of this study is to identify the factors associated with the use of sphincter-preserving surgery and to quantify the potential for an increase in sphincter preservation.
  
  
  METHODS
  This population-based retrospective cohort study used patient-level data collected through a comprehensive, standardized review of hospital inpatient and outpatient medical records and cancer center charts.
  
  
  METHODS
  This study was conducted in all hospitals providing rectal cancer surgery in a Canadian province.
  
  
  METHODS
  All patients with a new diagnosis of rectal cancer from July 1, 2002 to June 30, 2006 who underwent potentially curative radical surgery were included.
  
  
  METHODS
  Logistic regression was used to identify factors associated with receiving a permanent colostomy. Patients were categorized as having received an appropriate or potentially inappropriate colostomy based on a priori determined patient, tumor, operative, and pathologic criteria.
  
  
  RESULTS
  Of 466 patients who underwent radical surgery, 48% received a permanent colostomy. There was significant variation in the rate of sphincter-preserving surgery among the 10 hospitals that provided rectal cancer care (12%-73%, p = 0.0001). On multivariate analysis, male sex, low tumor height, and increasing tumor stage were associated with the receipt of a permanent colostomy. Among patients who received a permanent stoma, 65 of 224 (29%) patients received a potentially inappropriate stoma. On multivariate analysis, male sex and treatment in a medium- or low-volume hospital was associated with the receipt of a potentially inappropriate colostomy.
  
  
  CONCLUSIONS
  This study was limited by its retrospective design.
  
  
  CONCLUSIONS
  These data suggest that the receipt of a permanent colostomy by many patients with rectal cancer may be inappropriate, and there is potential to increase the use of sphincter-preserving surgery in patients with rectal cancer.
authors: Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors: Devon P
authors: DP
authors: Richardson
authors: Geoff A
authors: GA
authors: Porter
authors: Paul M
authors: PM
authors: Johnson
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D002170:Canada; D015331:Cohort Studies; D003125:Colostomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies