eP690 - Impact of Textbook Oncologic Outcomes Following Low Anterior Resection for Rectal Cancer

Purpose/Background: Textbook oncologic outcome (TOO) is a composite outcome measure attained when all desired short-term quality metrics are met following an oncologic operation. The objective of this study was to determine the incidence and impact of TOO following low anterior resection (LAR) among patients with non-metastatic rectal cancer.Methods/Interventions: The 2004-2017 National Cancer Database was queried for patients with non-metastatic rectal cancer who underwent LAR. TOO was defined as having met five metrics: resection with negative microscopic margins, adequate lymphadenectomy (LAD ≥ 12), no extended length of stay (LOS ≤ 75th percentile by year), no 30-day re-admission, and complete mesorectal excision (CME).Results/Outcomes: A total of 38,479 patients were identified, of which 20% attained TOO. The three most frequently attained TOO metrics included resection with negative margins (94%), no 30-day readmission (90.9%) and no extended LOS (78.1%). Patients who achieved TOO had a lower median age (59 vs 61 years old; p < 0.001), were more likely to have clinical (30.6% vs 27%; p < 0.001) and pathologic (4.4 vs 4.2%, p < 0.001) Stage I disease, and have undergone upfront surgery (47.5% vs 37.6, p < 0.001). Patients in the TOO cohort were also more likely to be privately insured (p < 0.001), and received treatment in an Academic/Research (p < 0.001) and very high-volume center (p < 0.001). The TOO cohort was more likely to be alive at 30 and 90-days following surgery (p < 0.001). Results of a multivariate model revealed that TOO attainment was associated with an increased likelihood of 5-year survival (AOR=1.19, p < 0.001). When risk of death was assessed using multivariate modeling, results showed that TOO attainment was associated with a reduced risk of death (HR=0.77; p < 0.001).Conclusion/

Discussion: TOO is achieved in approximately 20% of patients undergoing LAR for rectal cancer. When adjusting for sociodemographic, clinical and facility characteristics in multivariate analyses, results showed that TOO attainment was associated with a lower risk of death, as well as an increased likelihood of 5-year survival. Understanding the components necessary to achieve TOO will improve surgical outcomes and patient care.Figure 1Textbook oncologic outcome criteria following low anterior resection for rectal cancer. Bars depict the population percentage meeting each criterion. Solid line depicts the conditional percentage of patients meeting each quality indicator and all those previous to it. LAD, lymphadenectomy; LOS, postoperative length of stay; TOO, textbook oncologic outcome; CME, Complete Mesorectal Excision.