Surgical and Oncologic Textbook Outcomes in Abdominoperineal Resection for Rectal Adenocarcinoma. A Multi-Institutional Retrospective Study

The incidence of low rectal adenocarcinoma has increased. Surgery plays an important role in achieving optimal outcomes. Measuring surgical and oncological quality parameters helps to identify variables that need correction and reduces costs. To evaluate the results of applying quality parameters known as textbook outcomes (TO) in abdominoperineal resection (APR) due to lower rectal adenocarcinoma. The variables comprising the surgical textbook outcomes (STO) and oncological textbook outcomes (OTO) were evaluated in 192 patients undergoing APR for rectal adenocarcinoma. Variables that affected compliance with quality measures were also analyzed. Of the 192 patients, 37% met the STO and 37.5% met the OTO. Complications and R0 resections were the factors that most affected STO compliance. Minimally invasive surgery was associated with higher adherence compared to open surgery. Age over 65 years, transfusions, and incomplete mesorectal resection were variables associated with noncompliance. Noncompliance with TO is associated with a higher rate of recurrence. Implementing quality assessment through STO and OTO helps identify weak points in outcomes, target improvement interventions, and reduce costs.