EP101 - Concordance Across Radiology, Surgery, and Pathology and Short-Term Outcomes After Abdominoperineal Resection for Rectal Cancer at an NAPRC-Accredited Center

ePoster Presenter(s)

• 

  Loree Beth Thornton, MD

  Colorectal Surgery Fellow PGY 6
  Baylor University Medical Center
  Baylor University Medical Center
  Dallas, TX, United States

  Disclosure information not submitted.

Author(s)

• 

  Arielle Brackett, MD (she/her/hers)

  Colon and Rectal Surgery Fellow
  Baylor University Medical Center
  Baylor University Medical Center
  Dallas, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AH

  Abdul Hassan, MD, MAS

  Colon and Rectal Surgery Fellow
  Baylor University Medical Center
  Dallas, Texas, United States

  Disclosure information not submitted.
• WL

  Warren Lichliter, MD

  Surgeon
  Baylor Scott & White Health
  dallas, Texas, United States

  Disclosure information not submitted.
• 

  Katerina O.K Wells, MD MPH (she/her/hers)

  Chief, Division of Colon and Rectal Surgery, Baylor University Medical Center, Dallas
  Baylor University Medical Center, Dallas
  Baylor University Medical Center, Dallas
  Dallas, TX, United States

  Disclosure information not submitted.
• 

  Sarah Stringfield, MD (she/her/hers)

  Attending
  Baylor University Medical Center
  Texas A&M College of Medicine
  Dallas, TX, United States

  Disclosure information not submitted.
• GO

  Gerald Ogola, PhD

  Biostatistician
  Baylor Scott & White Health
  Dallas, Texas, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  James W. Fleshman, Jr., MD

  Surgeon
  Baylor Scott & White Health
  Dallas, Texas, United States

  Disclosure information not submitted.

Purpose/Background: High-quality rectal cancer care requires coordinated assessments from multidisciplinary teams. It relies on various disciplines coming to agreement on treatment to provide optimum care for our patients. Although the National Accreditation Program for Rectal Cancer (NAPRC) emphasizes multidisciplinary evaluation, the effect of interdisciplinary concordance on outcomes is not well defined. Our objective is to determine whether concordance among radiologists, surgeons, and pathologists in key rectal cancer quality domains is associated with short-term oncologic outcomes after abdominoperineal resection (APR).

Methods/Interventions: We performed a retrospective study of NAPRC data at a tertiary care medical center including patients with rectal adenocarcinoma treated with APR between 2021-2024. Concordance was assessed across three domains: (1) preoperative MRI-predicted circumferential resection margin (CRM); (2) operative synoptic report (resection completeness and total mesorectal excision [TME] grade); and (3) pathology (CRM status and TME grade). We calculated concordance proportions between pairs of specialties and across all three. The primary outcome was local recurrence. All statistical analysis were conducted with R version 4.0.3 statistical software. All statistical tests were two-sided with a statistical significance level set at p values < 0.05.

Results/Outcomes: Sixty APR cases met inclusion criteria with complete synoptic MRI, operative, and pathology documentation. Radiology-pathology CRM findings were concordant in 59.2% of cases. Surgery-pathology TME grading was concordant in 66.7%. Radiology CRM-surgical resection completeness was concordant in 60.5%. Full three-way concordance (radiology CRM, surgical completeness, and pathology CRM all aligned) occurred in only 50.0% of cases. On individual predictors, pathology-negative CRM was associated with lower local recurrence (p=0.02). Three-way concordance was not significantly associated with decreased local recurrence in this cohort.

Conclusion/Discussion: In this single-center NAPRC cohort of patients that underwent APR, cross-disciplinary concordance was modest (≈50%) and not independently associated with short-term decreased local recurrence, whereas pathology-negative CRM remained prognostic. These findings support continued emphasis on high-quality pathology margin assessment and suggest that larger, multicenter studies (with agreement statistics such as κ and risk-adjusted models) are needed to clarify how multidisciplinary concordance influences outcomes.

Table 2
Illustrates recurrence status based on radiology CRM status, Surgeon TME grade, Surgeon Completeness of resection, Pathology TME grade, Pathology CRM status. Also shows recurrence status based on concordant findings between pathology, radiology, and surgery.
Table 1
Overall summary of statistics demonstrating concordant findings between Radiology CRM and Pathology CRM, Surgeon TME and Pathology TME, Radiology MRI CRM and Surgeon completeness of resection, and Radiology, Surgery, and Pathology findings.