Evidence map›Paper›PMID 30706375›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2019

Surgeon-Level Variation in Utilization of Local Staging and Neoadjuvant Therapy for Stage II-III Rectal Adenocarcinoma.

Douglas S Swords, David E Skarda, William T Sause, Ute Gawlick, George M Cannon, Mark A Lewis, Courtney L Scaife, Jesse A Gygi, H Tae Kim

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Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Facility Variation in Local Staging of Rectal Adenocarcinoma and its Contribution to Underutilization of Neoadjuvant Therapy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Douglas S SwordsSurgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA. douglas.swords@hsc.utah.edu.ORCID 0000-0002-5002-6992
David E SkardaSurgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
William T SauseOncology Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
Ute GawlickSurgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
George M CannonOncology Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
Mark A LewisOncology Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
Courtney L ScaifeDepartment of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
Jesse A GygiOncology Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
H Tae KimSurgical Services Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionNeoadjuvant therapy (NT) is the standard of care for clinical stage II-III rectal adenocarcinoma, but utilization remains suboptimal. We aimed to determine the underlying reasons for omission of local staging and NT.

methodsWe conducted a retrospective study of patients with clinical stage II-III or undocumented clinical stage/pathologic stage II-III rectal adenocarcinoma who were treated in 2010-2016 in one of nine Intermountain Healthcare hospitals. The outcomes of omission of local staging and NT were examined with multivariable models. Risk- and reliability-adjusted rates of local staging and NT were calculated for surgeons who treated ≥ 3 patients. Pathologic and long-term outcomes were examined after excluding patients who were not resected or who underwent local excision (N = 11).

resultsLocal staging was omitted in 43/240 (17.9%) patients and NT was omitted in 41/240 (17.1%). The strongest risk factors for local staging and NT omission were upper rectal tumors and surgeons who treated ≤ 3 cases/year. Thirty-six of 41 (87.8%) cases of omitted NT had local staging omitted. Adjusted surgeon-specific local staging rates varied 1.6-fold (56.3-92.4%) and NT rates varied 2.8-fold (34.1-97.1%). Surgeon local staging and NT rates were strongly correlated (r = 0.92). NT was associated with lower rates of positive circumferential radial margins (7.9 vs. 20.0%; P = 0.02), node positivity (33.3 vs. 55.0%; P = 0.01), and local recurrences (7.6 vs. 14.9% at 5 years; P = 0.0176).

conclusionsNT omission should be understood as a consequence of surgeon failure to perform local staging in most cases. Quality improvement efforts should focus on improving utilization of local staging.

Indexed as

AdenocarcinomaAdultAgedAged, 80 and overChemoradiotherapy, AdjuvantFemaleFollow-Up StudiesHealthcare DisparitiesHumansMaleMargins of ExcisionMiddle AgedNeoadjuvant TherapyNeoplasm Recurrence, LocalNeoplasm StagingPractice Patterns, Physicians'Centers of excellenceClinical stagingDisparitiesEUSLocally advancedLocal stagingLocoregional stagingMRINational Accreditation Program for Rectal CancerNeoadjuvant chemoradiotherapyNeoadjuvant treatmentOSTRICH ConsortiumPreoperativeRectal cancer

Identifiers

PMID30706375

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.