@article {Ricciardi:August 2007:0012-3706:1119,
	author = "Ricciardi, Rocco",
	author = "Virnig, Beth",
	author = "Madoff, Robert",
	author = "Rothenberger, David",
	author = "Baxter, Nancy",
	title = "The Status of Radical Proctectomy and Sphincter-Sparing Surgery in the United States",
	journal = "Diseases of the Colon & Rectum",
	volume = "50",
	year = "August 2007",
	abstract = "Worldwide, &#8220;centers of excellence&#8221; in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70-90 percent) after proctectomy. The rate of sphincter-sparing surgery with reestablishment of intestinal continuity in the general population of the United Stares is unknown.<P></P>We used data from the Nationwide Inpatient Sample, a 20 percent stratified random sample of patients admitted to hospitals in the United States. We identified patients with rectal cancer from 1988 through 2003 who underwent sphincter-sparing surgery with reestablishment of intestinal continuity or proctectomy with colostomy. To determine predictors of sphincter-sparing surgery with reestablishment of intestinal continuity, we constructed a multivariate model that analyzed patients' age, gender, race, insurance status, and income level.<P></P>During our 16-year study period, radical extirpative procedures were performed in 41,631 patients: 16,510 (39.7 percent) sphincter-sparing surgery with reestablishment of intestinal continuity, and 25,121 (60.3 percent) sphincter-sacrificing procedures. The proportion of sphincter-sparing procedures increased from 26.9 percent in 1988 to 48.3 percent in 2003 (<I>P</I>&#8201;&#60;&#8201;0.001). There has been no significant change in the rate of sphincter-sparing surgery since 1999 (<I>P</I>&#8201;=&#8201;not significant). Logistic regression revealed that patients who were older, male, black, used Medicaid insurance, or lived in lower-income zip codes were less likely to have sphincter-sparing surgery with reestablishment of intestinal continuity (<I>P</I>&#8201;&#60;&#8201;0.001).<P></P>Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes.",
	pages = "1119-1127(9)",
	url = "http://www.ingentaconnect.com/content/klu/10350/2007/00000050/00000008/00000250"
	doi = "doi:10.1007/s10350-007-0250-5"
}