Use of a national registry to define a composite quality metric for rectal cancer


Quality assessment in oncologic surgery has traditionally involved reporting discrete
metrics that may be difficult for patients and referring providers to interpret. We
define a composite quality metric (CQM) for resection in rectal cancer.


We queried the National Cancer Database to identify patients undergoing low anterior
resection for clinical stage II-III rectal adenocarcinoma between 2010 and 2017. CQM
was defined as appropriate neoadjuvant therapy, margin-negative resection, appropriate
lymph node assessment, postoperative length of stay (LOS) < 75th percentile, and no
30-day readmission or mortality.


19,721 patients met inclusion criteria; 8,083 (41%) had a CQM. The most common reasons
for failure to achieve CQM: inadequate node assessment (27%), prolonged LOS (26%).
On Cox modeling, CQM (aHR 0.70, 95% CI [0.66, 0.75]) was associated with improved
overall survival.


CQM is independently associated with improved survival in rectal cancer and may be
an effective measure of quality.

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