{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:45:57Z","timestamp":1792759557709,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>In the era of multidisciplinary cancer care, proctectomy remains an essential procedure in treating rectal cancer. However, the current rates of optimal surgical resection in the US are unknown. This study examined the rates, hospital variation and factors associated with optimal surgical resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with clinically locally advanced (cT3\u2010T4 and\/or cN1\u20102) rectal adenocarcinoma who underwent proctectomy between 2021 and 2023 were identified within the National Cancer Database (NCDB). Optimal surgical resection was a composite metric defined as complete total mesorectal excision (TME), negative surgical margins and adequate lymph node yield (LNY) \u226512. Mixed\u2010effects multivariable analyses were performed to assess the association between optimal surgical resection and overall survival, identify factors associated with optimal surgical resection and assess hospital variation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6,183 patients, the optimal surgical resection rate was 59.2% (complete TME\u2009=\u200978.6%, negative surgical margins\u2009=\u200985.4%, adequate LNY\u2009=\u200983.7%). Optimal surgical resection was independently associated with longer overall survival (HR\u2009=\u20090.62, 95%CI\u2009=\u20090.48\u20130.80). Older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and Black race (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) were independently associated with lower odds of achieving optimal surgical resection. There was wide variation in adjusted optimal surgical resection rates across hospitals (range\u2009=\u200930%\u201382%), and higher hospital volume was associated with optimal surgical resection (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Possible disparities in achieving optimal surgical resection were identified among older and Black patients. In addition, there is wide hospital variation in achieving optimal surgical resection along with a direct correlation between higher hospital volume and optimal surgical resection. These findings support selective referral to medium\u2010to\u2010high volume centres to achieve better outcomes and future research into the aetiology of these possible disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70657","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:39:31Z","timestamp":1792489171000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Current rates, hospital variation and factors associated with optimal surgical resection of rectal cancer in the United States"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7216-1300","authenticated-orcid":false,"given":"Lampros","family":"Karakozis","sequence":"first","affiliation":[{"name":"Surgical Health Outcomes Consortium (SHOC) AdventHealth Digestive Health Institute  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9874-693X","authenticated-orcid":false,"given":"Michael","family":"Abdelmasseh","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Consortium (SHOC) AdventHealth Digestive Health Institute  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Soliman","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Consortium (SHOC) AdventHealth Digestive Health Institute  Orlando Florida USA"},{"name":"Department of Colon and Rectal Surgery AdventHealth  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2723-0618","authenticated-orcid":false,"given":"Matthew","family":"Albert","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Consortium (SHOC) AdventHealth Digestive Health Institute  Orlando Florida USA"},{"name":"Department of Colon and Rectal Surgery AdventHealth  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Kelly","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Consortium (SHOC) AdventHealth Digestive Health Institute  Orlando Florida USA"},{"name":"Department of Colon and Rectal Surgery AdventHealth  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1247-1072","authenticated-orcid":false,"given":"John R. T.","family":"Monson","sequence":"additional","affiliation":[{"name":"Wake Forest University  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7589-5561","authenticated-orcid":false,"given":"Christopher T.","family":"Aquina","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Consortium (SHOC) AdventHealth Digestive Health Institute  Orlando Florida USA"},{"name":"Department of Colon and Rectal Surgery AdventHealth  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21820"},{"key":"e_1_2_12_3_1","unstructured":"National Comprehensive Cancer Network.Rectal Cancer (Version 4.2024).https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/rectal.pdf. Accessed January 8 2025"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.4845"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.14.3281"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24136"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2007.12.7027"},{"key":"e_1_2_12_8_1","first-page":"1024","volume-title":"American joint committee on cancer","author":"Amin MB","year":"2017"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23848"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2001.19.1.157"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010002\u20100468\u20106"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010006\u20100756\u20102"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2009.02153.x"},{"key":"e_1_2_12_14_1","unstructured":"Standards for Oncology Registry Entry.American College of Surgeons.https:\/\/www.facs.org\/media\/j5bp1dn4\/store\u20102023\u2010final\u2010version\u201006282023.pdf. Accessed on January 8 2025"},{"key":"e_1_2_12_15_1","unstructured":"College of American Pathologists.Protocol for the Examination of Specimens from Patients with Primary Carcinoma of the Colon and Rectum (Version 3.4.0.0).https:\/\/documents.cap.org\/protocols\/cp\u2010colon\u2010rectum\u20102016\u2010v3400.pdf. Accessed January 8 2025"},{"key":"e_1_2_12_16_1","unstructured":"CoC Quality of Care Measures.Commission on Cancer.https:\/\/www.facs.org\/quality\u2010programs\/cancer\u2010programs\/national\u2010cancer\u2010database\/quality\u2010of\u2010care\u2010measures\/. Accessed January 8 2025"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/107497"},{"key":"e_1_2_12_18_1","unstructured":"Commission on Cancer.About cancer program categories.https:\/\/www.facs.org\/quality\u2010programs\/cancer\u2010programs\/commission\u2010on\u2010cancer\/coc\u2010accreditation\/categories\/. Accessed January 8 2025"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0003\u20104975(01)03222\u20102"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.4794"},{"key":"e_1_2_12_21_1","unstructured":"Centers for Medicare & Medicaid Services.Mortality measures methodology.https:\/\/qualitynet.cms.gov\/inpatient\/measures\/mortality\/methodology. Accessed January 8 2025"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sopen.2023.09.005"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000001391"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2021.02.029"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010012\u20102722\u20107"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2012.03179.x"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.3747\/co.v15i2.245"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000005667"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0068526"},{"issue":"4","key":"e_1_2_12_30_1","first-page":"1854","article-title":"Factors associated with lymph node retrieval in surgery for colorectal cancer","volume":"25","author":"Katsoulis IE","year":"2020","journal-title":"J BUON"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2009.12.006"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S328666"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.10.031"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13193\u2010020\u201001162\u2010y"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2007.01256.x"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0b013e3181efc142"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010026\u201019197\u2010w"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14153817"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol31070280"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.11.029"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010020\u201008509\u20103"},{"key":"e_1_2_12_42_1","unstructured":"Leapfrog Group.Safety in numbers: hospital performance on leapfrog's surgical volume standard based on results of the 2019 leapfrog's hospital survey.https:\/\/www.leapfroggroup.org\/sites\/default\/files\/Files\/Leapfrog%20Report%20on%20Safe%20Surgical%20Volumes%202020.pdf. Accessed January 8 2025"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.02.029"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70657","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.70657","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70657","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:12:02Z","timestamp":1792757522000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.70657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":42,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/codi.70657"],"URL":"https:\/\/doi.org\/10.1111\/codi.70657","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70657"}}