Trends of sphincter-preserving surgeries for low lying rectal cancer: A 20-year experience in China

Kuo Zheng; Qingqing Hu; Guanyu Yu; Leqi Zhou; Yuting Yao; Yuan Zhou; Hao Wang; Liqiang Hao; Enda Yu; Zheng Lou; Yongjing Zhang; Hong Qiu; Ronggui Meng; Wei Zhang

doi:10.3389/fonc.2022.996866

Trends of sphincter-preserving surgeries for low lying rectal cancer: A 20-year experience in China

Front Oncol. 2022 Dec 8:12:996866. doi: 10.3389/fonc.2022.996866. eCollection 2022.

Authors

Kuo Zheng¹, Qingqing Hu², Guanyu Yu¹, Leqi Zhou¹, Yuting Yao³, Yuan Zhou³, Hao Wang¹, Liqiang Hao¹, Enda Yu¹, Zheng Lou¹, Yongjing Zhang², Hong Qiu², Ronggui Meng¹, Wei Zhang¹

Affiliations

¹ Department of Colorectal Surgery, Changhai Hospital, Shanghai, China.
² Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China.
³ Department of Professional Education, Johnson & Johnson Medical (Shanghai) LTD, Shanghai, China.

Abstract

Background: Over the last 2 decades, patients with low rectal cancer have had better outcomes from improvements in surgical techniques in sphincter preservation. We aimed to quantify the trends in sphincter-preserving surgeries for low rectal cancer over 20 years in a top tertiary hospital in China.

Methods: Between 1999 and 2021, a cohort of patients with primary malignant rectal tumor ≤5cm from the anal verge and who received elective surgeries at Changhai Hospital, Shanghai, China, was identified. Data were extracted from electronic medical records. A Joinpoint Regression Model was used to analyze trends in surgical procedures by average annual percentage change (AAPC). Adjusted Cox proportional hazards regression model was used to assess overall survival.

Results: Among a total of 4,172 patients during the study period, 3,111 (74.6%) underwent a sphincter-preserving surgery and 1,061 (25.4%) received APR. Sphincter-preserving surgery increased 3.6% per year (95%CI, 2.3-4.9). Low anterior resection was the most performed procedure (86.3%) and maintained a steady trend, while intersphincteric resection increased 49.4% annually (95%CI, 19.5-86.7) after initiation. Laparoscopic techniques increased 15.1% per year (95%CI, 8.4-43.4) after initiation. Sphincter-preserving surgery increased annually for tumors ≤2cm, 2-≤3cm and 3-≤4cm from the anal verge (AAPC 7.1, 4.5-9.8; 4.7, 3.1-6.3; 2.7, 1.7-3.6, respectively). Furthermore, patients with sphincter-preserving surgery had a better overall survival than abdominoperineal resection (APR) patients (adjusted HR 0.78, 95% CI, 0.65-0.93, p=.01).

Conclusions: Utilization of sphincter-preserving surgeries increased significantly over the last 20 years. Patients with low rectal cancer who underwent sphincter preservation had better survival than similar patients who underwent APR.

Keywords: abdominoperineal resection; low anterior resection; low rectal cancer; rectal cancer survival; sphincter preservation; trends in surgery.