EP163 - Disparities in Sphincter-Sparing Surgery for Rectal Cancer: A Study of patients from a low-middle and high income country.

Saturday, May 10, 2025

3:20 PM – 3:25 PM PT

Location: Monitor 9, Sails Pavilion, Upper Level

Author(s)

MA

Mohammad Kumael Azhar, MBBS

Research Associate
Aga Khan University
Karachi, Sindh, Pakistan

Disclosure information not submitted.
SK

Sadaf Khan, MBBS ABS ABCRS

Professor of Surgery
Aga Khan University
Karachi, Sindh, Pakistan

Disclosure information not submitted.

ePoster Presenter(s)

Danish Ali, MD

Research Intern
Vanderbilt University Medical Center
Nashville, TN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SK

Shahid Khattak, FRCS

Consultant General Surgeon
Shaukat Khanum Memorial Cancer Hospital and Research Centre
Lahore, Punjab, Pakistan

Disclosure information not submitted.
HK

Hadi M. Khan, n/a

Consultant Surgical Oncologist
Shifa International Hospital
Islamabad, Islamabad, Pakistan

Disclosure information not submitted.
GS

Ghina Shamsi, MBBS, FCPS, FRCS

Head of General Surgery
Indus Hospital And Health Network
Karachi, Sindh, Pakistan

Disclosure information not submitted.
KA

Khursheed Ahmed, n/a

Consultant General Surgeon
Dr. Ruth K. M. Pfau Civil Hospital Karachi
Karachi, Sindh, Pakistan

Disclosure information not submitted.
FS

Faisal Siddiqi, MBBS, FCPS. FRCS

Associate Professor
Liaquat National Hospital
Karachi, Sindh, Pakistan

Disclosure information not submitted.
SB

Saleema Begum, MBBS, FCPS, FRCS

Assistant Professor
Aga Khan University
Karachi, Sindh, Pakistan

Disclosure information not submitted.
ZR

Zeeshan Nasir Rifat, MBBS

Assistant Professor
Aga Khan University
Karachi, Sindh, Pakistan

Disclosure information not submitted.
Phillip J. Williams, MD, MSc

Colon and Rectal Surgery Fellow
Vanderbilt University Medical Center
Nashville, TN, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Alexander T. Hawkins, MD, MPH

Associate Professor
Vanderbilt University Medical Center
VIMC
Nashville, Tennessee, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Aimal Khan, MD

Assistant Professor of Surgery
Vanderbilt University Medical Center

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Danish Ali, danish.ali@vumc.org: This individual has no financial relationships with ineligible companies.

Phillip J. Williams, MD, MSc: This individual has no financial relationships with ineligible companies.

Alexander T. Hawkins, MD, MPH: This individual has no financial relationships with ineligible companies.

Aimal Khan, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Surgery remains a cornerstone of treatment for rectal cancer, with sphincter-preserving surgery being offered to the majority of patients in developed nations. Little is known about the rate and predictive factors associated with sphincter-preserving surgery in low-middle-income countries. In this study, we assess the factors associated with the receipt of sphincter-preserving surgery for rectal cancer. We hypothesize that rectal cancer patients in a low-middle-income country (Pakistan) are less likely to receive sphincter-preserving surgery compared to patients in a high-income country (United States).

Methods/Interventions: This was a retrospective study conducted from two multi-institutional rectal cancer databases in Pakistan and the United States (US). Only patients undergoing surgical management for primary rectal adenocarcinoma located within 15 cm of the anal verge were included. Baseline characteristics were compared using the Chi-squared test for categorical variables and the t-test for continuous variables. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the likelihood of patients receiving sphincter-preserving surgery.

Results/Outcomes: A total of 1,672 patients were included in the final analysis, 309 from Pakistan and 1,363 from the US. The proportion of patients receiving sphincter-preserving surgery was significantly higher in the US compared to Pakistan (69.9% vs. 45.0%, p < 0.01). Patients in Pakistan were younger than those in the US (mean age 43.2 ± 13.7 vs. 59.7 ± 12.7 years, p < 0.01). The mean distance of tumors from the anal verge was also shorter in patients from Pakistan (4.99 ± 3.59 cm vs. 6.80 ± 3.89 cm, p < 0.01). Additionally, a higher percentage of patients presented with Stage II/III disease at diagnosis in Pakistan compared to the US (72.2% vs. 43.4%, p < 0.01). On multivariate analysis, adjusting for distance from anal verge, country of origin, T stage, histopathological grade and subtype, neoadjuvant chemotherapy and radiation therapy, being from the US (OR: 1.9, 95% CI 1.03, 3.51, p = 0.04) and a greater distance of the tumor from the anal verge (OR: 1.6, 95% CI 1.46, 1.72, p < 0.01) were associated with higher likelihood of receiving sphincter preserving surgery (Table 1).

Conclusion/Discussion: Patients with rectal cancer from the US are more likely to receive sphincter-preserving surgery compared to Pakistan; however, significant differences between populations warrant further investigation with more patients from Pakistan to identify the causes of this disparity.