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The importance of surgical resection in the management of rectal sarcoma: A national cancer database analysis of 133 cases

  • Michael R. Freund
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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  • Sameh Hany Emile
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt
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  • Nir Horesh
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
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  • Zoe Garoufalia
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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  • Rachel Gefen
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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  • Steven D. Wexner
    Correspondence
    Corresponding author. Corresponding author. Cleveland Clinic Florida, Department of Colorectal Surgery, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
    Search for articles by this author
Published:October 19, 2022DOI:https://doi.org/10.1016/j.ejso.2022.10.014

      Abstract

      Background and purpose

      Rectal sarcomas (RS) are rare malignant tumors with a very poor prognosis. This study aimed to assess the characteristics, treatment, and outcomes of RS in the United States.

      Methods

      This study was a retrospective analysis of the National Cancer Database (NCDB) from 2004 to 2019 of patients with a diagnosis of RS. The main outcome measures were overall survival (OS) and its predictors.

      Results

      133 RS patients (39.1% female) with a mean age of 65.7 ± 15.6 years were included in the study. Mean tumor size was 6.1 ± 3 cm. The crude OS rate was 22.5% and median survival duration was 10.1 (IQR: 3.2–21) months. Factors associated with an improved OS on were private insurance (HR = 0.23, p = 0.001) and undergoing surgery (HR 0.23, p < 0.001), Factors associated with poor survival were age (HR 1.02, p = 0.005), male sex (HR 2.27, p = 0.001), Charlson score of 3 (HR 5.17, p = 0.003), and positive resection margins (HR: 2.64, p = 0.01). Multivariate Cox regression analysis revealed that male sex (HR 2.16, p = 0.04) and positive resection margins (HR 2.31, p = 0.03) were predictors of poor survival whereas surgery was an independent predictor of improved OS (HR 0.321, p < 0.001)

      Conclusions

      RS is a very rare rectal malignancy with an even poorer prognosis than previously reported. However, undergoing surgery with curative intent while obtaining negative margins may confer better OS.

      Keywords

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