Short-term surgical outcomes of rectal adenocarcinoma surgical treatment in Latin America: a multicenter, retrospective assessment in 49 centers from 12 countries
Authors:   LATAM collaborative colorectal surgery consortium, Nicolas Avellaneda , Valdivieso Sebastian , Leiro Fabio , Gonzalez Marcos , Malet Marcelo Viola , Moreira Junior Helio , Isaacs Reinaldo , Licango-Naranjo Eddy P. , Carrie Augusto , Pellino Gianluca , Antonino Spinelli , Caycedo-Marulanda Antonio , Santillán Mateo , Berasategui Delfina , Mayne Camila Bustamante , Brun Martina , Pantoja Pachajoa Diana Alejandra , Parodi Matías , Martiarena Rosario , Schlain Sergio , Bras Harriott Camila , Rotholtz Nicolas , Bun Maximiliano , Potolicchio Analía Inés , Quiroga Yenny , Carballo Federico Héctor Enrique , Farina Pablo , Vaccaro Carlos , González Marcos , Sedziszow Simón , Ortigueira Gaston , Seip Tomas , Brosutti Oscar Dalzio , Cian María Soledad , Leiro Fabio Oscar , Bianchi Romina , Espino Campagna Julieta Yanet , Cedermas Mariela , Arbios Pablo , Alesandrini Agustín , Perriello Juan Alberto , Villaggi Javier Ignacio , Barbero Florencia , Giordanino Juan Manuel , Nari Gustavo Adrián , Muñoz Juan Pablo , Gesto Natalia Mira , Medina Federico , Minoldo Javier Santiago , Zanoni Gerardo , Lucas Cristian Nicolas , Nielsen Debra , Sotelo Juan Manuel , Leone Ana Inés , Posner Federico , Barletta Diego Hernán , Ferrufino Méndez Christian Abel , Parra Rogerio Serafim , Lopes de Queiroz Fabio , Londoño Estrada Daniel Mauricio , Medeiros de Almeida Romulo , de Sousa João Batista , Alves Martins Bruno Augusto , Craveiro Marcela Maria Silvino , Saad-Hossne Rogerio , Barrera Zamorano Augusto Antonio , Barrera Escobar Alejandro Nicolas , Benavides Yáñez Claudio Patricio , Ocares Urzua Benedicto Misael , Báez Rojas Francisco Xavier , Contreras Rivas Tomas Sebastian , Bellolio Roth Felipe , Moreno Miranda Daniel , Altamirano Christophe Riquoir , Iglesias Bettini Andrés , Niño Puentes Nelson , Labrador Morales María Sofia , Correa Cote Juan Camilo , López Gustavo Adolfo , Sierra Castaño Daniela , Dorado Mauricio Gonzales , Lanza Diaz Andrés Ramiro , Bruno Cao Víctor Hugo , Pereira Jessica Capre , Babilonia Yepes Rosana María , Padilla Herrera Cristina Judith , Martínez López Luis Eduardo , Pacheco Trujillo Maikel Adolfo , Barreras González Javier Ernesto , Pereira Fraga Jorge Gerardo , Torres Peña Rafael , Martínez Alfonso Miguel Ángel , David Renato Silva Segovia , Rivadeneira Proaño Francisco David , López-Gómez Javier , Jaramillo Romero Aldo Hernán , López Ramírez Mario Alberto , Zeron Pontones Pablo , Brito Toledo Ismael , Hernández Valadez Michel , Ramirez-Gaona Adan , Palacio Magaña Josue , Núñez González Roberto Ángel , Solórzano Vanegas Marisol , Salazar Álvarez María Alejandra , Medina Diarte Carlos Alberto , Dominguez Azuaga Ruben , Pequeño Martínez María Alejandra , Laurini Zanola Marcelo , Soumastre Alejandro , Duran Federico , Duffau Furini Alexandra , Vásquez Chirinos Felix Luis Edgar , Martínez-Millán Sergio Antonio , Vicent Vásquez Edibel Sabrina , Solorzano Vásquez Maryeli Josefina , Viola Malet Marcelo 
Published: December 2024

Abstract
Introduction
Rectal cancer is a prevalent disease that requires multidisciplinary management. Results of treatment of patients suffering from this malignancy in Latin America have been scarcely reported before.

Methods
A retrospective, multicenter study was conducted to report preoperative and operative characteristics of patients intervened for rectal cancer in centers from Latin America during 2015–2022, and the short-term results of treatment were analyzed. The study was open to any center receiving rectal cancer patients, irrespective of volume. The main study outcome was 30-day postoperative complications including any deviation from the normal postoperative course (Clavien Dindo I to V).

Results
A total of 2044 patients from 49 centers in 12 Latin American countries were included, with a mean age of 63 years. Twenty-five percent of patients were operated in low-volume centers. Twenty-nine percent of patients had a tumor located in the low rectum, and only 53% of patients had preoperative MRI for local staging. A total of 1052 patients (52%) received neoadjuvant therapy before surgery. Eighty-six percent of patients were operated by a specialized colorectal surgeon, and 31% of patients were intervened using a conventional approach. A total of 29.9% of patients presented a postoperative complication. The anastomotic leak rate was 8.9%. Fifty-eight percent of pathology reports had less than 12 lymph nodes harvested, and 22.9% of reports did not include mesorectal quality. In the multivariate analysis, neoadjuvant therapy (OR: 1.44, p-value: 0.023), urgent procedures (OR: 3.73, p-value: 0.049), intraoperative complications (OR: 2.21, p-value: 0.046), advanced tumors (OR: 1.39, p-value: 0.036), and prolonged surgery (OR: 1.74, p-value: 0.004) were found to be independently related to suffering postoperative complications.

Conclusions
This study includes information about the approach and results of rectal cancer management in Latin America at a large scale. In the future, this information can be used as a bridge to identify areas of improvement among rectal cancer patients’ treatment in the region.