Regional variance in treatment and outcomes of locally invasive (T4) rectal cancer in Australia and New Zealand: analysis of the Bi-National Colorectal Cancer Audit

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dc.contributor.authorDinger, T.L.
dc.contributor.authorKroon, H.M.
dc.contributor.authorTraeger, L.
dc.contributor.authorBedrikovetski, S.
dc.contributor.authorHunter, A.
dc.contributor.authorSammour, T.
dc.date.issued2022
dc.description.abstractBACKGROUNDS: Locally invasive T4 rectal cancer often requires neoadjuvant treatment followed by multi-visceral surgery to achieve a radical resection (R0), and referral to a specialized exenteration quaternary centre is typically recommended. The aim of this study was to explore regional variance in treatment and outcomes of patients with locally advanced rectal cancer in Australia and New Zealand (ANZ). METHODS: Data were collected from the Bi-National Colorectal Cancer Audit (BCCA) database. Rectal cancer patients treated between 2007 and 2019 were divided into six groups based on region (state/country) using patient postcode. A subset analysis of patients with T4 cancer was performed. Primary outcomes were positive circumferential resection margin (CRM+), and positive circumferential and/or distal resection margin (CRM/DRM+). RESULTS: A total of 9385 patients with rectal cancer were identified, with an overall CRM+ rate of 6.4% and CRM/DRM+ rate of 8.6%. There were 1350 patients with T4 rectal cancer (14.4%). For these patients, CRM+ rate was 18.5%, and CRM/DRM+ rate was 24.1%. Significant regional variation in CRM+ (range 13.4-26.0%; p = 0.025) and CRM/DRM+ rates (range 16.1-29.3%; p = 0.005) was identified. In addition, regions with higher CRM+ and CRM/DRM+ rates reported lower rates of multi-visceral resections: range 24.3-26.8%, versus 32.6-37.3% for regions with lower CRM+ and CRM/DRM+ rates (p < 0.0001). CONCLUSION: Positive resection margins and rates of multi-visceral resection vary between the different regions of ANZ. A small subset of patients with T4 rectal cancer are particularly at risk, further supporting the concept of referral to specialized exenteration centres for potentially curative multi-visceral resection.
dc.description.statementofresponsibilityTessa L. Dinger, Hidde M. Kroon, Luke Traeger, Sergei Bedrikovetski, Andrew Hunter and Tarik Sammour
dc.identifier.citationANZ Journal of Surgery, 2022; 92(7-8):1772-1780
dc.identifier.doi10.1111/ans.17699
dc.identifier.issn1445-1433
dc.identifier.issn1445-2197
dc.identifier.orcidKroon, H.M. [0000-0002-8923-7527]
dc.identifier.orcidTraeger, L. [0000-0002-0327-7334]
dc.identifier.orcidBedrikovetski, S. [0000-0001-9330-625X]
dc.identifier.orcidSammour, T. [0000-0002-4918-8871]
dc.identifier.urihttps://hdl.handle.net/2440/140013
dc.language.isoen
dc.publisherWiley
dc.rights© 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons. This is an open access article under the terms of the Creative Commons Attribution- NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is noncommercial and no modifications or adaptations are made.
dc.source.urihttps://doi.org/10.1111/ans.17699
dc.subjectcentralized care
dc.subjectlocally invasive
dc.subjectpelvic exenteration
dc.subjectrectal cancer
dc.subjectresection margins
dc.subject.meshHumans
dc.subject.meshRectal Neoplasms
dc.subject.meshNeoplasm Recurrence, Local
dc.subject.meshNeoplasm Staging
dc.subject.meshTreatment Outcome
dc.subject.meshRetrospective Studies
dc.subject.meshAustralia
dc.subject.meshNew Zealand
dc.subject.meshMargins of Excision
dc.titleRegional variance in treatment and outcomes of locally invasive (T4) rectal cancer in Australia and New Zealand: analysis of the Bi-National Colorectal Cancer Audit
dc.typeJournal article
pubs.publication-statusPublished

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