Commission on Cancer Standard 5.7 Compliance and Technical Quality of Rectal Cancer Surgery: A National Cohort Study.

BACKGROUND: Commission on Cancer Operative Standard 5.7 requires documentation of complete or near-complete total mesorectal excision (TME) for eligible rectal cancer resections, but it is unknown whether facility compliance with Standard 5.7 reflects established measures of surgical quality. STUDY DESIGN: Retrospective cohort study of the National Cancer Database linked to Commission on Cancer accreditation data. Adults aged 18-90 years with clinical stage I-III rectal adenocarcinoma undergoing resection at Commission on Cancer-accredited facilities between 2020 and 2023 were compared according to facility Standard 5.7 compliance. Primary outcomes were circumferential resection margin (CRM) positivity and TME grade; secondary outcomes included lymph node yield. Mixed-effects regression models adjusted for age, sex, Charlson-Deyo Comorbidity Index, clinical T stage, clinical N stage, tumor grade, and lymphovascular invasion. RESULTS: Among 22,688 patients treated at 873 facilities, 91% underwent surgery at compliant hospitals. CRM positivity was lower at compliant facilities (12% vs 14%; adjusted OR 0.82, 95% CI 0.68-0.99; P=0.04). Patients treated at compliant facilities had greater odds of achieving a more complete TME (adjusted OR 1.63, 95% CI 1.21-2.19; P=0.001), with lower rates of incomplete TME (9% vs 14%; P<0.001). Although ≥12 lymph nodes were examined more frequently at compliant facilities (85% vs 81%; P<0.001), this association was not significant after adjustment (adjusted OR 1.24, 95% CI 0.99-1.55; P=0.06). CONCLUSIONS: Standard 5.7 compliance was independently associated with lower CRM positivity and more complete TME, suggesting that Standard 5.7 represents a meaningful facility-level indicator of technical quality in rectal cancer surgery. Whether these differences translate into improved long-term oncologic outcomes requires further study.