Evaluation of the National Accreditation Program for Rectal Cancer and Association with Oncologic Outcomes After Proctectomy

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Abstract
Background: Circumferential resection margin (CRM) positivity is a validated predictor of local recurrence and survival in rectal cancer and reflects multidisciplinary care quality. The National Accreditation Program for Rectal Cancer (NAPRC), launched in 2017, standardizes rectal cancer care, but national oncologic outcome data remain limited. Study Design: We performed a retrospective National Cancer Database analysis of clinical stage I–III rectal adenocarcinoma (2015–2022) treated with curative-intent proctectomy using a stacked difference-in-differences design. Hospitals accredited between 2018–2021 were compared with inverse probability of treatment weighting–matched non-accredited hospitals. The primary endpoint was annual hospital-level CRM positivity (CRM 60 days. Models included hospital, calendar year, and accreditation year fixed effects with robust standard errors clustered by hospital. Results: Among 58,510 patients treated at 800 hospitals, 57 hospitals (7.1%) achieved accreditation, exposing 2,716 patients to accreditation. CRM positivity declined from 14.9% to 12.0% at accredited hospitals versus 14.4% to 12.6% at non-accredited hospitals, yielding a −1.1 percentage point difference-in-differences (95% CI 0.2–2.0; p=0.03), corresponding to an 8.7% relative reduction. CEA measurement increased from 84.0% to 89.5% versus 84.0% to 85.3%, a +4.2 percentage point difference-in-differences (95% CI 3.6–4.8; p<0.001). There was no significant differential change in treatment delays (+0.7 percentage points; p=0.15). Conclusions: NAPRC accreditation was associated with reduced CRM positivity and increased adherence to pre-treatment CEA testing without prolonging treatment initiation. These findings suggest structured multidisciplinary accreditation is associated with measurable improvements in rectal cancer surgical quality at the national level.