EP459 - Predictors of local excision versus proctectomy in stage I-III rectal cancer

Sunday, May 11, 2025

12:51 PM – 12:56 PM PT

Location: Monitor 9, Sails Pavilion, Upper Level

ePoster Presenter(s)

Alyssa Habermann, MD (she/her/hers)

General Surgery Resident
Virginia Commonwealth University
Virginia Commonwealth University
Richmond, VA, United States

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

Author(s)

KO

Kathryn Ottaviano, MD

Resident Physician
Albany Medical Center
Delmar, New York, United States

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

Stacy Ranson, MD

Colorectal Surgeon
VCU Health System
Richmond, Virginia, United States

Disclosure information not submitted.
DN

Deaquan Jawoi Nichols, B.S.

Medical Student
Virginia Commonwealth University School of Medicine
Richmond, Virginia, United States

Disclosure information not submitted.
PC

Patrick Chizek, DO

Colorectal Fellow
VCU
Richmond, Virginia, United States

Disclosure information not submitted.
AA

Ashar Ata, MBBS, MPH, PHD

Assistant Professor
Albany Medical College
Albany, New York, United States

Disclosure information not submitted.

Senior Author(s)

SS

Stephen P. Sharp, MD, FACS, FASCRS

Assistant Professor of Surgery
Virginia Commonwealth University
Richmond, Virginia, United States

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.

Alyssa Habermann, MD: This individual has no financial relationships with ineligible companies.

Kathryn Ottaviano, MD: This individual has no financial relationships with ineligible companies.

Stephen P. Sharp, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: For selected patients, local excision is an appropriate treatment for early stage rectal cancers which allows for organ preservation compared to proctectomy. Our study aims to compare rates of local excision across region, race, income, and other patient-specific criteria.

Methods/Interventions: Using the National Cancer Database, data were collected for patients with stage I-III rectal cancer who underwent local excision versus proctectomy from 2004-2021. To determine likelihood of undergoing local excision versus proctectomy, chi-squared test was used to compare preoperative patient and disease characteristics, and logistic regression was used to perform multivariate analysis. Modified Poisson multivariate regression was used to compare the overall rate of local excision between race groups as well as local excision between race groups for stage I, II, and III rectal cancers individually.

Results/Outcomes: A total of 32,851 patients underwent local excision. Patient factors including age, sex, facility type, insurance status, and distance from facility, influenced rate of local excision. Disease factors including grade and analytic stage influenced rate of local excision (Table 1). Overall, non-Hispanic Black (NHB), Hispanic, and other non-White patients were more likely to undergo local excision than their non-Hispanic White (NHW) counterparts (OR 2.18 [2.08, 2.28], 1.30 [1.22, ,1.38], and 1.47 [1.39, 1.56], respectively), even when adjusted for income, education, insurance, rurality, distance from facility, facility region, and comorbidities (Figure 1). Odds of local excision for stage I disease yielded similar results (OR 2.42 [2.30, 2.55], 1.37 [1.28, 1.47], and 1.59 [1.50, 1.70], respectively). Odds of local excision for stage II disease was increased for NHB patients compared to NHW patients (OR 1.66 [1.45, 1.89]) but similar for Hispanic and other non-White patients compared to NHW patients. Odds of local excision for stage III disease were similar across race groups.

Conclusion/Discussion: Many patient and disease factors, such as age, sex, insurance status, distance from facility, grade, and clinical T stage influence the rate of local excision versus proctectomy. Minority patients were more likely to undergo local excision for rectal cancer, both overall and for stage I, than NHW patients. NHB patients are also more likely than NHW patients to undergo local excision for stage II disease, which is typically reserved only for select stage II cancers.