HMN 2026: How rectal cancer surgery may affect whether the cancer comes back

Patients treated for rectal cancer at hospitals that are accredited by the American College of Surgeons (ACS) National Accreditation Program for Rectal Cancer (NAPRC) were less likely to have cancer left behind after surgery, a major factor for recurrence, according to a new study published in the Journal of the American College of Surgeons. The findings reinforce that where patients receive care can significantly influence their outcomes.

Researchers found that NAPRC-accredited hospitals delivered higher-quality care on several key measures compared with non-accredited hospitals, including more comprehensive presurgical testing and improved surgical outcomes.

“Rectal cancer treatment is complex, and these findings show that specialized, accredited programs from the American College of Surgeons can make a meaningful difference for patients,” said study co-author Ronald J. Weigel, MD, PhD, MBA, FACS, medical director of ACS Cancer Programs. “For patients and families facing a rectal cancer diagnosis, these findings reinforce the importance of asking where care is being received and whether a hospital has been accredited.”

Researchers found that patients treated at NAPRC-accredited hospitals were less likely to have cancer cells remaining at the edges of tissue removed during surgery, which is known as a positive surgical margin and is strongly associated with cancer recurrence.

Further, treatment at an NAPRC-accredited hospital was associated with increased pre-treatment testing for the protein carcinoembryonic antigen (CEA), which can be elevated in people with rectal cancer. When patients get this blood test before surgery, it can help with treatment decision making and monitoring for cancer recurrence after treatment.

“For patients, this translates to potentially better long-term outcomes. Accreditation standards help ensure patients receive evidence-based treatment from teams experienced in managing rectal cancer,” said Bailey K. Hilty Chu, MD, study co-author and a general surgery resident at University of Rochester Medical Center in Rochester, New York. “It’s important to talk to your provider about the standards of care set in place for the condition you have, and specifically for rectal cancer, make sure you are getting treatments that are recommended.”

Using the National Cancer Database (NCDB), which includes oncology data from more than 1,500 facilities accredited by the ACS Commission on Cancer (CoC), researchers evaluated the effect of NAPRC accreditation on outcomes among rectal cancer patients. The researchers assessed the annual circumferential resection margin (CRM) positivity rate, which refers to the unseen cancer remaining at the edges of tissue at the surgery site, rates of pretreatment CEA testing, and delayed start of treatment (greater than 60 days).

• In an adjusted analysis accounting for differences between NAPRC-accredited and non-accredited hospitals, NAPRC status was associated with an absolute reduction in CRM positivity of 1.1%, representing an 8.7% relative reduction compared to non-accredited hospitals.
• NAPRC status was associated with a 4.2% absolute increase in pretreatment CEA testing, and a 5% relative increase (84% to 89.5%) compared to non-accredited hospitals (84% to 85.3%).
• No difference was seen in treatment initiation rates.
• Of 800 hospitals included, 57 (7.1%) achieved NAPRC accreditation between 2018-2021. Overall, 2,716 patients received rectal cancer care at NAPRC-accredited hospitals.

Accreditation ensures that the hospital has met rigorous standards for high-quality care, including infrastructure, staff education and training, and experience with the procedure.

Accredited programs also saw increased patient volume

In a separate study recently published in JAMA Surgery, researchers found that NAPRC-accredited hospitals treated more rectal cancer patients after achieving accreditation without increasing fragmentation of care, suggesting accreditation is financially achievable for hospitals and patients may increasingly seek specialized centers while still receiving coordinated treatment.

“For patients, the take-home message is to do your research about where you are getting care and look for accredited institutions,” Dr. Hilty Chu said. “The time and money invested in implementing the NAPRC accreditation program has a return on investment both for the accredited hospitals and, importantly, the patients treated at those hospitals.”

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