Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer

Kilian G M Brown; Michael J Solomon; Cherry E Koh; Paul A Sutton; Samuel Aguiar; Tiago S Bezerra; Hamish W Clouston; Ashwin Desouza; Eric J Dozois; Amanda L Ersryd; Frank Frizelle; Jonas A Funder; Julio Garcia-Aguilar; Richard Garfinkle; Tamara Glyn; Alexander Heriot; Yukihide Kanemitsu; Chia Y Kong; Helle Ø Kristensen; Songphol Malakorn; David M Mens; Per J Nilsson; Gabriella J Palmer; Emmanouil Pappou; Martha Quinn; Aaron J Quyn; Chucheep Sahakitrungruang; Avanish Saklani; Arne M Solbakken; Jim P Tiernan; Cornelis Verhoef; Daniel Steffens

doi:10.1097/sla.0000000000006348

Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer

Kilian G M Brown, Michael J Solomon, Cherry E Koh, Paul A Sutton, Samuel Aguiar, Tiago S Bezerra, Hamish W Clouston, Ashwin Desouza, Eric J Dozois, Amanda L Ersryd, Frank Frizelle, Jonas A Funder, Julio Garcia-Aguilar, Richard Garfinkle, Tamara Glyn, Alexander Heriot, Yukihide Kanemitsu, Chia Y Kong, Helle Ø Kristensen, Songphol MalakornDavid M Mens, Per J Nilsson, Gabriella J Palmer, Emmanouil Pappou, Martha Quinn, Aaron J Quyn, Chucheep Sahakitrungruang, Avanish Saklani, Arne M Solbakken, Jim P Tiernan, Cornelis Verhoef, Daniel Steffens

Surgery

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Abstract

OBJECTIVE: To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary (LARC) and recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres.

BACKGROUND DATA: PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement.

METHODS: This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres.

RESULTS: 763 patients underwent PE, of which 464 patients (61%) had LARC and 299 (39%) had LRRC. 544 patients (71%) who met predefined lower risk criteria formed the benchmark cohort. For LARC patients, the calculated benchmark threshold for major complication rate was ≤44%; comprehensive complication index (CCI): ≤30.2; 30-day mortality rate: 0%; 90-day mortality rate: ≤4.3%; R0 resection rate: ≥79%. For LRRC patients, the calculated benchmark threshold for major complication rate was ≤53%; CCI: ≤34.1; 30-day mortality rate: 0%; 90-day mortality rate: ≤6%; R0 resection rate: ≥77%.

CONCLUSIONS: The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.

Original language	English
Journal	Annals of Surgery
Early online date	15 May 2024
DOIs	https://doi.org/10.1097/sla.0000000000006348
Publication status	Published - May 2024

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Defining Benchmarks for Pelvic Exenteration Surgery_A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal CancerAccepted author manuscript, 1.29 MBLicence: Article 25fa Dutch Copyright Act

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Brown, K. G. M., Solomon, M. J., Koh, C. E., Sutton, P. A., Aguiar, S., Bezerra, T. S., Clouston, H. W., Desouza, A., Dozois, E. J., Ersryd, A. L., Frizelle, F., Funder, J. A., Garcia-Aguilar, J., Garfinkle, R., Glyn, T., Heriot, A., Kanemitsu, Y., Kong, C. Y., Kristensen, H. Ø., ... Steffens, D. (2024). Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer. Annals of Surgery. https://doi.org/10.1097/sla.0000000000006348

@article{b456139d1d274fd0b4e5ef4d6b4ea15a,

title = "Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer",

abstract = "OBJECTIVE: To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary (LARC) and recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres.BACKGROUND DATA: PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement.METHODS: This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres.RESULTS: 763 patients underwent PE, of which 464 patients (61\%) had LARC and 299 (39\%) had LRRC. 544 patients (71\%) who met predefined lower risk criteria formed the benchmark cohort. For LARC patients, the calculated benchmark threshold for major complication rate was ≤44\%; comprehensive complication index (CCI): ≤30.2; 30-day mortality rate: 0\%; 90-day mortality rate: ≤4.3\%; R0 resection rate: ≥79\%. For LRRC patients, the calculated benchmark threshold for major complication rate was ≤53\%; CCI: ≤34.1; 30-day mortality rate: 0\%; 90-day mortality rate: ≤6\%; R0 resection rate: ≥77\%.CONCLUSIONS: The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.",

author = "Brown, \{Kilian G M\} and Solomon, \{Michael J\} and Koh, \{Cherry E\} and Sutton, \{Paul A\} and Samuel Aguiar and Bezerra, \{Tiago S\} and Clouston, \{Hamish W\} and Ashwin Desouza and Dozois, \{Eric J\} and Ersryd, \{Amanda L\} and Frank Frizelle and Funder, \{Jonas A\} and Julio Garcia-Aguilar and Richard Garfinkle and Tamara Glyn and Alexander Heriot and Yukihide Kanemitsu and Kong, \{Chia Y\} and Kristensen, \{Helle {\O}\} and Songphol Malakorn and Mens, \{David M\} and Nilsson, \{Per J\} and Palmer, \{Gabriella J\} and Emmanouil Pappou and Martha Quinn and Quyn, \{Aaron J\} and Chucheep Sahakitrungruang and Avanish Saklani and Solbakken, \{Arne M\} and Tiernan, \{Jim P\} and Cornelis Verhoef and Daniel Steffens",

year = "2024",

month = may,

doi = "10.1097/sla.0000000000006348",

language = "English",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "Wolters Kluwer Health",

}

Brown, KGM, Solomon, MJ, Koh, CE, Sutton, PA, Aguiar, S, Bezerra, TS, Clouston, HW, Desouza, A, Dozois, EJ, Ersryd, AL, Frizelle, F, Funder, JA, Garcia-Aguilar, J, Garfinkle, R, Glyn, T, Heriot, A, Kanemitsu, Y, Kong, CY, Kristensen, HØ, Malakorn, S, Mens, DM, Nilsson, PJ, Palmer, GJ, Pappou, E, Quinn, M, Quyn, AJ, Sahakitrungruang, C, Saklani, A, Solbakken, AM, Tiernan, JP, Verhoef, C & Steffens, D 2024, 'Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer', Annals of Surgery. https://doi.org/10.1097/sla.0000000000006348

TY - JOUR

T1 - Defining Benchmarks for Pelvic Exenteration Surgery

T2 - A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer

AU - Brown, Kilian G M

AU - Solomon, Michael J

AU - Koh, Cherry E

AU - Sutton, Paul A

AU - Aguiar, Samuel

AU - Bezerra, Tiago S

AU - Clouston, Hamish W

AU - Desouza, Ashwin

AU - Dozois, Eric J

AU - Ersryd, Amanda L

AU - Frizelle, Frank

AU - Funder, Jonas A

AU - Garcia-Aguilar, Julio

AU - Garfinkle, Richard

AU - Glyn, Tamara

AU - Heriot, Alexander

AU - Kanemitsu, Yukihide

AU - Kong, Chia Y

AU - Kristensen, Helle Ø

AU - Malakorn, Songphol

AU - Mens, David M

AU - Nilsson, Per J

AU - Palmer, Gabriella J

AU - Pappou, Emmanouil

AU - Quinn, Martha

AU - Quyn, Aaron J

AU - Sahakitrungruang, Chucheep

AU - Saklani, Avanish

AU - Solbakken, Arne M

AU - Tiernan, Jim P

AU - Verhoef, Cornelis

AU - Steffens, Daniel

PY - 2024/5

Y1 - 2024/5

N2 - OBJECTIVE: To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary (LARC) and recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres.BACKGROUND DATA: PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement.METHODS: This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres.RESULTS: 763 patients underwent PE, of which 464 patients (61%) had LARC and 299 (39%) had LRRC. 544 patients (71%) who met predefined lower risk criteria formed the benchmark cohort. For LARC patients, the calculated benchmark threshold for major complication rate was ≤44%; comprehensive complication index (CCI): ≤30.2; 30-day mortality rate: 0%; 90-day mortality rate: ≤4.3%; R0 resection rate: ≥79%. For LRRC patients, the calculated benchmark threshold for major complication rate was ≤53%; CCI: ≤34.1; 30-day mortality rate: 0%; 90-day mortality rate: ≤6%; R0 resection rate: ≥77%.CONCLUSIONS: The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.

AB - OBJECTIVE: To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary (LARC) and recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres.BACKGROUND DATA: PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement.METHODS: This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres.RESULTS: 763 patients underwent PE, of which 464 patients (61%) had LARC and 299 (39%) had LRRC. 544 patients (71%) who met predefined lower risk criteria formed the benchmark cohort. For LARC patients, the calculated benchmark threshold for major complication rate was ≤44%; comprehensive complication index (CCI): ≤30.2; 30-day mortality rate: 0%; 90-day mortality rate: ≤4.3%; R0 resection rate: ≥79%. For LRRC patients, the calculated benchmark threshold for major complication rate was ≤53%; CCI: ≤34.1; 30-day mortality rate: 0%; 90-day mortality rate: ≤6%; R0 resection rate: ≥77%.CONCLUSIONS: The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.

U2 - 10.1097/sla.0000000000006348

DO - 10.1097/sla.0000000000006348

M3 - Article

C2 - 38747145

SN - 0003-4932

JO - Annals of Surgery

JF - Annals of Surgery

ER -

Defining Benchmarks for Pelvic Exenteration Surgery: A Multicentre Analysis of Patients with Locally Advanced and Recurrent Rectal Cancer

Abstract

Bibliographical note

UN SDGs

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