2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:Tbc3,Hospital accreditation programs aim to improve quality of care and patient outcomes but often require substantial institutional investment in staffing, infrastructure, and regulatory compliance. Despite these costs, the broader institutional impact of accreditation, particularly on patient volumes and care patterns, are poorly understood. To evaluate whether National Accreditation Program for Rectal Cancer (NAPRC) accreditation is associated with changes in rectal cancer patient volume, stage-specific procedural volumes, and care fragmentation. This cohort study used a quasi-experimental difference-in-differences design. A total of 316 US Commission on Cancer-accredited (COC) hospitals, including 80 that received NAPRC-accreditation and 236 matched nonaccredited centers. Participants included adult patients diagnosed with primary rectal adenocarcinoma between 2010 and 2022 from the National Cancer Database. These data were analyzed from April 2025 to August 2025. Hospital-level NAPRC accreditation, which requires adherence to multidisciplinary rectal cancer care standards, external audits, and specialized training. Annual hospital-level rectal cancer patient volume, stage-specific procedural volumes (stage I and stage II/III), and care fragmentation. Care fragmentation was defined as any case in which the diagnosis and first-course treatment (or decision not to treat) were not completed at the reporting COC-accredited facility. Outcomes were assessed using linear fixed-effects multivariable regression models. Prior to matching, 1336 COC-accredited facilities were identified, including 80 that achieved NAPRC accreditation and 1256 that never attained accreditation. After propensity score matching, the final analytic sample included 316 hospitals: 80 NAPRC-accredited and 236 nonaccredited facilities. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per institution (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first postaccreditation year, with larger point estimates in subsequent years, though later estimates were not statistically significant. Accreditation was associated with an increase in stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), but not stage II/III surgical volume. No significant changes in care fragmentation were observed. In this study, NAPRC accreditation was associated with increased institutional rectal cancer patient volumes and higher procedural volume for early-stage disease without evidence of increased care fragmentation. These findings suggest that accreditation may promote institutional growth while preserving care continuity, offering a potential strategic incentive for hospitals to pursue NAPRC accreditation beyond quality improvement alone. Understanding these dynamics may inform hospital investment decisions, payer strategies, and policy efforts to support high-quality oncologic care delivery.31:T116e, Importance Hospital accreditation programs aim to improve quality of care and patient outcomes but often require substantial institutional investment in staffing, infrastructure, and regulatory compliance. Despite these costs, the broader institutional impact of accreditation, particularly on patient volumes and care patterns, are poorly understood. Objective To evaluate whether National Accreditation Program for Rectal Cancer (NAPRC) accreditation is associated with changes in rectal cancer patient volume, stage-specific procedural volumes, and care fragmentation. Design, Setting, and Participants This cohort study used a quasi-experimental difference-in-differences design. A total of 316 US Commission on Cancer–accredited (COC) hospitals, including 80 that received NAPRC-accreditation and 236 matched nonaccredited centers. Participants included adult patients diagnosed with primary rectal adenocarcinoma between 2010 and 2022 from the National Cancer Database. These data were analyzed from April 2025 to August 2025. Exposure Hospital-level NAPRC accreditation, which requires adherence to multidisciplinary rectal cancer care standards, external audits, and specialized training. Main Outcomes and Measures Annual hospital-level rectal cancer patient volume, stage-specific procedural volumes (stage I and stage II/III), and care fragmentation. Care fragmentation was defined as any case in which the diagnosis and first-course treatment (or decision not to treat) were not completed at the reporting COC-accredited facility. Outcomes were assessed using linear fixed-effects multivariable regression models. Results Prior to matching, 1336 COC-accredited facilities were identified, including 80 that achieved NAPRC accreditation and 1256 that never attained accreditation. After propensity score matching, the final analytic sample included 316 hospitals: 80 NAPRC-accredited and 236 nonaccredited facilities. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per institution (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first postaccreditation year, with larger point estimates in subsequent years, though later estimates were not statistically significant. Accreditation was associated with an increase in stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), but not stage II/III surgical volume. No significant changes in care fragmentation were observed. Conclusions and Relevance In this study, NAPRC accreditation was associated with increased institutional rectal cancer patient volumes and higher procedural volume for early-stage disease without evidence of increased care fragmentation. These findings suggest that accreditation may promote institutional growth while preserving care continuity, offering a potential strategic incentive for hospitals to pursue NAPRC accreditation beyond quality improvement alone. Understanding these dynamics may inform hospital investment decisions, payer strategies, and policy efforts to support high-quality oncologic care delivery. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Rectal Adenocarcinoma: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Rectal Adenocarcinoma (condition). 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Patients traveling the farthest (Q4 vs. Q1) had significantly better overall survival (HR 0.850, 95% CI 0.758–0.953, P=0.005). Longer travel was not associated with lower conversion-to-laparotomy rates, 30-day mortality, or higher lymph node yield.","limitations":"Retrospective design limits causal inference. The NCDB does not capture why patients traveled farther (e.g., referral patterns vs. personal choice), which may confound the survival association. Cause-specific survival data are unavailable in the NCDB, so only overall survival could be assessed.","practice_takeaway":"Patients with rectal cancer who travel greater distances for surgery tend to have better overall survival, likely reflecting treatment at higher-volume or academic centers. Clinicians should consider referral to specialized centers for stage II–III rectal cancer, particularly for patients in rural or low-resource settings."}},{"doi":"10.1002/jso.70322","pmid":"42437518","title":"National Trends in the Use of Palliative Therapy in Stage IV Rectal Cancer in the United States","journal_title":"Journal of Surgical Oncology","journal_issn":"0022-4790","published_at":"2026-07-12T00:00:00.000Z","url":"https://doi.org/10.1002/jso.70322","source_score":4,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-20T13:35:46.852Z","updated_at":"2026-07-20T13:35:46.852Z","tags":[{"paper_doi":"10.1002/jso.70322","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"condition","value":"Metastatic Colorectal Cancer","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"condition","value":"Rectal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"modality","value":"Immunotherapy","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"modality","value":"Palliative Surgery","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"modality","value":"Palliative Systemic Therapy","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"sample_size","value":"n=43443","value_numeric":43443},{"paper_doi":"10.1002/jso.70322","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"warning","value":"The NCDB palliative-intent variable is a coding field that may not uniformly reflect clinical intent across institutions, which could introduce misclassification bias.","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"warning","value":"The sharp rise in immunotherapy use in later years likely reflects expanding MSI-H/dMMR indications but this subgroup is not explicitly analyzed in the abstract.","value_numeric":null},{"paper_doi":"10.1002/jso.70322","tag_type":"warning","value":"The study does not report survival or quality-of-life outcomes, limiting assessment of whether increased palliative therapy translates to patient benefit.","value_numeric":null}],"summaries":{"what_studied":"A retrospective cohort study using the NCDB (2012–2023) evaluated national trends and disparities in palliative-intent therapy utilization among 43,443 adults with stage IV rectal adenocarcinoma.","key_result":"Palliative therapy use rose from 16.2% (2012) to 25.6% (2023); systemic therapy became the dominant modality while surgical palliation declined. Lower income (OR 1.82), brain metastases (OR 5.75), and immunotherapy use (OR 1.65) independently predicted palliative therapy receipt; primary tumor resection was inversely associated (OR 0.45).","limitations":"Retrospective NCDB design limits causal inference; the NCDB palliative-intent variable may not fully capture nuanced clinical intent; survival, quality-of-life, and symptom outcomes are not available in this dataset.","practice_takeaway":"Palliative-intent therapy in stage IV rectal cancer is increasingly systemic rather than surgical — clinicians should actively integrate palliative care pathways, particularly for lower-income patients and those with brain metastases who show higher utilization rates. Rising immunotherapy use in this setting warrants attention as an emerging palliative modality."}},{"doi":"10.1097/sla.0000000000007058","pmid":"42240534","title":"Predicting Treatment Response After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer","journal_title":"Annals of Surgery","journal_issn":"0003-4932","published_at":"2026-06-04T00:00:00.000Z","url":"https://doi.org/10.1097/sla.0000000000007058","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-09T13:50:22.519Z","updated_at":"2026-06-09T13:50:22.519Z","tags":[{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"condition","value":"Locally Advanced Rectal Cancer","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"condition","value":"Rectal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"modality","value":"Machine Learning / Foundation Model","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"modality","value":"Total Neoadjuvant Therapy","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"sample_size","value":"n=391","value_numeric":391},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"study_design","value":"Prediction Model Development and External Validation","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"warning","value":"The model's specific input variables and exact ensemble architecture are not described in the abstract, limiting reproducibility assessment.","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"warning","value":"The study design label 'Prediction Model Development and External Validation' is a non-standard design category; closest standard equivalents are retrospective cohort or prognostic model study.","value_numeric":null},{"paper_doi":"10.1097/sla.0000000000007058","tag_type":"warning","value":"Total sample size of n=391 combines the TNT+TME training cohort (n=308) and TNT+W/W external validation cohort (n=83); these are distinct populations with different endpoints (pCR vs. pcCR), so direct comparison of model performance metrics requires caution.","value_numeric":null}],"summaries":{"what_studied":"An ensemble tabular foundation model was fine-tuned to predict pathological complete response (pCR) after total neoadjuvant therapy (TNT) + total mesorectal excision (TME) in adults with clinical stage II–III microsatellite stable rectal adenocarcinoma (2018–2023), using pre-TNT, post-TNT, and pre-TME variables; it was then externally validated in a watch-and-wait (W/W) cohort to predict persistent clinical complete response (pcCR).","key_result":"In 308 TNT+TME patients, the model predicted pCR with AUROC 0.71 (95% CI 0.65–0.77), AUPRC 0.44 (95% CI 0.35–0.57), and Brier score 0.17. In 83 external TNT+W/W patients, it predicted pcCR with AUROC 0.69 (95% CI 0.57–0.82), AUPRC 0.90 (95% CI 0.82–0.96), and Brier score improving from 0.30 to 0.17 after recalibration.","limitations":"- External validation cohort was small (n=83) and limited to W/W patients, which may not generalize broadly.\n- The model requires recalibration before application in W/W settings, adding a step before clinical use.\n- Study restricted to microsatellite stable tumors, excluding MSI-high cases that may respond differently.","practice_takeaway":"This model offers good discrimination for pCR after TNT and may help identify rectal cancer patients suitable for watch-and-wait, but recalibration is needed before applying it to W/W cohorts. Prospective validation in larger W/W populations is still required before routine clinical adoption."}},{"doi":"10.1097/xcs.0000000000001915","pmid":"42153641","title":"Evaluation of the National Accreditation Program for Rectal Cancer and Association with Oncologic Outcomes After Proctectomy","journal_title":"Journal of the American College of Surgeons","journal_issn":"1072-7515","published_at":"2026-05-19T00:00:00.000Z","url":"https://doi.org/10.1097/xcs.0000000000001915","source_score":23,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-26T13:35:09.029Z","updated_at":"2026-05-26T13:35:09.029Z","tags":[{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"condition","value":"Rectal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"condition","value":"Rectal Cancer","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"modality","value":"Surgical Oncology","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"sample_size","value":"n=58510","value_numeric":58510},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"warning","value":"CRM positivity is a validated surrogate endpoint; the study does not report actual local recurrence rates or overall survival, so direct clinical impact remains inferred.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"warning","value":"Only 57 of 800 hospitals achieved accreditation — findings may not reflect what would happen if accreditation were more broadly adopted.","value_numeric":null},{"paper_doi":"10.1097/xcs.0000000000001915","tag_type":"warning","value":"The difference-in-differences design controls for observed confounders, but unmeasured selection bias (e.g., higher-performing or better-resourced hospitals self-selecting into NAPRC accreditation) cannot be ruled out.","value_numeric":null}],"summaries":{"what_studied":"Evaluated whether NAPRC accreditation (2018–2021) was associated with improved oncologic process outcomes in clinical stage I–III rectal adenocarcinoma treated with curative-intent proctectomy, using a retrospective National Cancer Database analysis (2015–2022) with a stacked difference-in-differences design comparing 57 accredited vs. matched non-accredited hospitals.","key_result":"NAPRC accreditation was associated with a statistically significant −1.1 percentage point reduction in CRM positivity (8.7% relative reduction; 95% CI 0.2–2.0; p=0.03) and a +4.2 percentage point increase in pre-treatment CEA measurement (95% CI 3.6–4.8; p<0.001), with no significant difference in treatment delays (+0.7 pp; p=0.15).","limitations":"- Only 7.1% of hospitals (57/800) achieved accreditation, limiting generalizability and statistical power.\n- Retrospective NCDB design cannot confirm causality; selection bias may exist if higher-performing hospitals pursued accreditation.\n- Long-term survival and local recurrence outcomes were not assessed — CRM positivity is a surrogate endpoint.","practice_takeaway":"Hospitals treating rectal cancer should consider pursuing NAPRC accreditation, as it is linked to lower CRM positivity and better adherence to CEA testing without delaying treatment start. These structured multidisciplinary standards appear to translate into measurable surgical quality gains at scale."}},{"doi":"10.1001/jamasurg.2026.1259","pmid":"42090174","title":"Association of Rectal Cancer Accreditation with Patient Volume and Procedural Trends in the US","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-05-06T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13150726/","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-11","doi":"10.1001/jamasurg.2026.1259","days":"7","issn":"2168-6254","rank":"7","field":"Clinical Medicine","score":"7","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1001/jamasurg.2026.1259","title":"Association of Rectal Cancer Accreditation with Patient Volume and Procedural Trends in the US.","journal":"JAMA surgery","methods":"","results":"Prior to matching, 1336 COC-accredited facilities were identified, including 80 that achieved NAPRC accreditation and 1256 that never attained accreditation. After propensity score matching, the final analytic sample included 316 hospitals: 80 NAPRC-accredited and 236 nonaccredited facilities. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per institution (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first postaccreditation year, with larger point estimates in subsequent years, though later estimates were not statistically significant. Accreditation was associated with an increase in stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), but not stage II/III surgical volume. No significant changes in care fragmentation were observed.","abstract":"$30","keywords":[],"pubmed_id":"42090174","conclusions":"","publication_date":"2026-05-06T00:00:00"},"crossref":{"DOI":"10.1001/jamasurg.2026.1259","URL":"https://doi.org/10.1001/jamasurg.2026.1259","ISSN":["2168-6254"],"link":[{"URL":"https://jamanetwork.com/journals/jamasurgery/articlepdf/2848646/jamasurgery_loria_2026_oi_260021_1777474152.16133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Association of Rectal Cancer Accreditation with Patient Volume and Procedural Trends in the US"],"author":[{"given":"Anthony","family":"Loria","sequence":"first","affiliation":[{"name":"Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York"}]},{"given":"Yusheng","family":"Jia","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York"},{"name":"Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York"}]},{"given":"Ronald J.","family":"Weigel","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Iowa Carver College of Medicine, Iowa City"}]},{"given":"Steven D.","family":"Wexner","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Medstar Georgetown University Health, Washington, DC"}]},{"given":"Ingrid M.","family":"Lizarraga","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Iowa Carver College of Medicine, Iowa City"}]},{"given":"Samantha","family":"Hendren","sequence":"additional","affiliation":[{"name":"Department of Surgery, Indiana University, Indianapolis"}]},{"given":"Yue","family":"Li","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York"},{"name":"Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York"}]},{"given":"Fergal J.","family":"Fleming","sequence":"additional","affiliation":[{"name":"Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New 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classification may vary.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1259","tag_type":"warning","value":"Full text was inaccessible; summary is based solely on the abstract and results excerpt provided.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1259","tag_type":"warning","value":"Outcomes reported are hospital-level volumes and fragmentation, not patient-level clinical outcomes.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1259","tag_type":"warning","value":"Sample size refers to hospitals, not individual patients.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1259","tag_type":"warning","value":"Sample size reflects hospitals (n=316), not individual patients — patient-level N from the National Cancer Database is not reported in the available abstract/results text.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1259","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously: the volume increases are statistically modest, and later-year estimates did not reach significance.","value_numeric":null}],"summaries":{"limitations":"- Later-year sensitivity estimates showed larger point estimates but lost statistical significance, limiting confidence in the magnitude of long-term volume gains.\n- The study relied on observational data with propensity score matching; unmeasured confounders (e.g., hospital marketing, regional competition) cannot be excluded.\n- Full text was not available for review; details on covariate selection and model specification are unverifiable.","what_studied":"A quasi-experimental difference-in-differences cohort of US Commission on Cancer–accredited hospitals (2010–2022) compared NAPRC-accredited centers (n=80) with matched nonaccredited centers (n=236) using NCDB data. Outcomes were annual hospital rectal cancer volume, stage-specific procedural volumes (stage I and stage II/III), and care fragmentation.","key_result":"NAPRC accreditation was associated with a mean annual increase of 4.3 rectal cancer patients per institution (β=4.29; 95% CI, 0.55-8.03; P=.03) and a rise in stage I procedural volume (β=1.01; 95% CI, 0.016-1.99; P=.05), with no increase in stage II/III surgical volume or in care fragmentation. Sensitivity analyses showed increases beginning in the first postaccreditation year, with larger but later statistically nonsignificant point estimates.","practice_takeaway":"For hospital leaders, NAPRC accreditation was linked to higher rectal cancer volumes and more stage I procedures without added care fragmentation, suggesting a growth benefit alongside quality aims. This can inform investment and planning around rectal cancer program development."}},{"doi":"10.1016/s2468-1253(26)00047-6","pmid":"42066786","title":"Effect of one or two cycles of dual immunotherapy with nivolumab and ipilimumab in patients with mismatch repair-deficient rectal cancer (RESET-R): interim results from a multicentre, single-arm, phase 2 trial","journal_title":"The Lancet Gastroenterology & Hepatology","journal_issn":"2468-1253","published_at":"2026-05-01T00:00:00.000Z","url":"https://doi.org/10.1016/s2468-1253(26)00047-6","source_score":24,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-15T13:21:57.767Z","updated_at":"2026-06-15T13:21:57.767Z","tags":[{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"brand","value":"Opdivo","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"brand","value":"Yervoy","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"category","value":"Gastroenterology & Hepatology","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"condition","value":"Mismatch Repair-Deficient Rectal Cancer","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"condition","value":"Rectal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"generic","value":"ipilimumab","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"generic","value":"nivolumab","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"modality","value":"CTLA-4 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"modality","value":"Dual Immune Checkpoint Blockade","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"modality","value":"PD-1 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"sample_size","value":"n=16","value_numeric":16},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"study_design","value":"Single-Arm Phase 2 Trial","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"warning","value":"Median follow-up of 16 months is insufficient to assess long-term organ preservation outcomes or late recurrences.","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the striking efficacy signal, but authors explicitly note the findings are preliminary and require confirmation with full enrolment and longer follow-up.","value_numeric":null},{"paper_doi":"10.1016/s2468-1253(26)00047-6","tag_type":"warning","value":"This is an early interim analysis of only 16 of a planned 39 patients; the 100% cCR rate should be interpreted with caution given the small sample and wide confidence interval (79.4–100.0%).","value_numeric":null}],"summaries":{"what_studied":"Short-course preoperative dual immune checkpoint blockade (nivolumab + ipilimumab, 1–2 cycles) was evaluated in 16 patients with histologically confirmed stage I–III dMMR rectal adenocarcinoma in a single-arm phase 2 trial (RESET-R) conducted at two Danish hospitals, with the primary endpoint of clinical complete response (cCR) at day 93.","key_result":"All 16 patients (100%; 95% CI 79.4–100.0) achieved cCR by day 93—11 after one cycle and 5 after two cycles. No patient required chemoradiotherapy or surgery. No recurrence or progression was observed at median follow-up of 16 months (IQR 9–18). Grade 3 immune-related adverse events occurred in 3 patients (19%); no grade 4/5 toxicities or treatment-related deaths were reported.","limitations":"- Very small interim cohort (n=16); full planned enrolment is 39 patients.\n- Single-arm design with no comparator group.\n- Follow-up is short (median 16 months), so durability of cCR and organ-preservation safety remain unconfirmed.","practice_takeaway":"In dMMR rectal cancer, just 1–2 cycles of nivolumab plus ipilimumab may be enough to achieve complete clinical response and avoid surgery entirely—a striking early signal. Until full enrolment and longer follow-up data are available, this approach should remain within clinical trial settings."}},{"doi":"10.1001/jamasurg.2026.1036","pmid":"42018309","title":"Prevention of Parastomal Hernia With Funnel-Shaped Intra-Abdominal Mesh vs No Mesh for Rectal Adenocarcinoma Surgery","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-04-22T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13103874/","source_score":23,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-07T22:49:21.929Z","updated_at":"2026-05-07T22:49:21.929Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"condition","value":"Parastomal Hernia","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"condition","value":"Rectal Adenocarcinoma","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"modality","value":"Surgical Mesh","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"sample_size","value":"n=143","value_numeric":143},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"warning","value":"Dropout was substantial: only 101 of 143 randomized patients were available at 3-year follow-up, and CT scans were obtained in fewer still (44 mesh, 39 control), which may introduce selection bias in the primary endpoint.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"warning","value":"The level of evidence is rated 2 (high-quality RCT) rather than 1 due to single-blind design and notable attrition.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1036","tag_type":"warning","value":"The trial was conducted in Finland and Sweden; results may not generalize to other healthcare settings or surgical volumes.","value_numeric":null}],"summaries":{"what_studied":"The Chimney Trial evaluated whether a funnel-shaped intra-abdominal parastomal mesh placed at the time of laparoscopic or robotic abdominoperineal excision (APE) or Hartmann procedure for rectal adenocarcinoma reduces parastomal hernia (PSH) incidence over 3 years, compared to no mesh (143 randomized; 101 available at 3-year follow-up).","key_result":"CT-confirmed PSH at 3 years was significantly lower in the mesh group vs control (57% vs 82%; difference −25%, 95% CI −42% to −5%; P = .001). Clinically diagnosed PSH was also lower (10% vs 39%; difference −29%, 95% CI −44% to −13%; P < .001). PSH volume was smaller with mesh (median 86.8 mL vs 185.9 mL; P = .003). No significant difference in complications was found.","limitations":"- Substantial dropout by 3 years reduced analyzable CT cohort to 44 (mesh) and 39 (control) patients, limiting statistical power.\n- Single-blinded design (patients not blinded) in a relatively small multicenter trial.\n- CT scans were not obtained in all surviving patients, introducing potential ascertainment bias for the primary endpoint.","practice_takeaway":"Consider placing a funnel-shaped parastomal mesh at the time of permanent colostomy formation (APE or Hartmann) for rectal cancer — it roughly halves the clinical PSH rate at 3 years without increasing complications. This evidence supports routine prophylactic mesh use in eligible patients."}}],"initialOffset":7,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Rectal Adenocarcinoma"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Rectal Adenocarcinoma"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Rectal Adenocarcinoma"}}}]]

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