EP766 - Risk Factors Associated With Incomplete Total Mesorectal Excision

ePoster Presenter(s)

• 

  Wissal Alsheikh, MD MS

  Resident
  Advocate Health, University of illinois Chicago
  Advocate Surgery
  Oak Lawn, IL, United States

  Disclosure information not submitted.

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Author(s)

• 

  Narjes Sweis, MD

  Research Fellow
  The University of Illinois Chicago
  chicago, IL, United States

  Disclosure information not submitted.

Senior Author(s)

• GG

  Gerald Gantt, MD

  Associate Professor of Surgery
  University of Illinois Chicago
  Chicago, Illinois, United States

  Disclosure information not submitted.

Author(s)

• EB

  Elisa Bianchi, MD

  Colorectal Surgeon
  University of Illinois at Chicago
  chicago, Illinois, United States

  Disclosure information not submitted.
• BO

  Brendan O'Donnell, MD

  Assistant Professor
  University of Illinois Chicago
  Chicago, Illinois, United States

  Disclosure information not submitted.
• VC

  Vivek Chaudhry, MD, FACS, FASCRS

  Clin Prof of Surgery
  University of Illinois
  Chicago, Illinois, United States

  Disclosure information not submitted.
• MA

  Mohamad A. Abdulhai, MD

  Assistant Professor of Surgery
  University of Illinois at Chicago College of Medicine
  Chicago, Illinois, United States

  Disclosure information not submitted.
• AP

  Alejandra Perez-Tamayo, MD

  Assistant Professor of Surgery
  University of Illinois Chicago
  Chicago, Illinois, United States

  Disclosure information not submitted.

Purpose/Background: Total mesorectal excision (TME) is the cornerstone of surgical management in rectal cancer, strongly influencing local recurrence and oncologic outcomes. While clinical trials have identified technical and anatomical challenges impacting TME quality, real-world patterns remain underexplored, particularly in the modern era of minimally invasive surgery.

Methods/Interventions: We conducted a retrospective cohort study using data from the National Cancer Database, including patients diagnosed with rectal cancer in 2022 and 2023 who underwent surgical resection. TME quality was categorized as complete (including near-complete) or incomplete. Multivariable logistic regression was performed to identify factors associated with incomplete TME, adjusting for clinical, demographic, and institutional variables.

Results/Outcomes: A total of 12,025 procedures were included in the analysis, of which 58.6% robotic, 18.2% laparoscopic, and 23.2% were open. Higher T stage was significantly associated with incomplete TME-T3 (OR 1.87, p = 0.008) and T4 (OR 3.73, p < 0.001). Increasing age at diagnosis was associated with slightly higher odds of incomplete TME (OR 1.016 per year, p < 0.001). Compared with open surgery, laparoscopic (OR 0.64, p < 0.001) and robotic (OR 0.62, p < 0.001) approaches were associated with significantly lower odds of incomplete resection. Compared to uninsured patients, those with private insurance (OR 0.38, p < 0.001) and Medicare (OR 0.46, p < 0.001) had lower odds of incomplete TME. Patient race, sex, and facility type were not associated with increased odds of incomplete TME.

Conclusion/Discussion: Tumor characteristics are strongly associated with TME quality. In real-world practice, minimally invasive approaches are linked to lower rates of incomplete mesorectal excision. These findings underscore the ongoing evolution of rectal cancer surgery and support broader adoption of advanced minimally invasive techniques to optimize oncologic outcomes.

Table 1: Results
Risk Factors Associated with Incomplete Total Mesorectal Excision.