Comparison of surgical treatment patterns and temporal trends for stage I-III invasive rectal adenocarcinoma among regions in the United States

<h2>Abstract</h2><h3>Background</h3> Practice patterns of surgical management of rectal adenocarcinoma vary among US regions. Nationwide, there has been an overall trend toward the performance of anterior resection (AR) over abdominoperineal resection (APR) in the surgical management of invasive rectal adenocarcinoma when feasible. It is suspected that this trend is adopted at a slower rate in underserved regions of the United States. <h3>Methods</h3> Data from the NCDB for 2004–2019 was queried for patients with stage I-III rectal adenocarcinoma who underwent anterior resection (AR) or abdominoperineal resection (APR). Comparisons of AR versus APR were made among year, region, approach, and stage. <h3>Results</h3> Of 160,070 cases, 73,673 (76.0 %) underwent AR and 23,273 (24 %) underwent APR. AR rate in 2016–2019 was 77.6 % versus 74.2 % in 2004–2007. APR rate in 2016–2019 was 22.4 % versus 25.8 % in 2004–2007. AR rate was highest in Middle Atlantic. APR rate was highest in West North Central. Robotic approach was highest in West North Central. Laparoscopic approach was highest in New England. Open/unspecified approach was highest in East South Central. <h3>Conclusions</h3> AR cases are trending upward with a corresponding downward trend in APR cases. Adoption of AR is gradual and varies among regions, but rates of APR still remain high.