Allison N Martin1, Puja Shah Berry1, Charles M Friel1, Traci L Hedrick2. 1. Department of Surgery, Section of Colon and Rectal Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA. 2. Department of Surgery, Section of Colon and Rectal Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22908-0709, USA. th8q@virginia.edu.
Abstract
BACKGROUND: Minimally invasive surgery (MIS) for rectal cancer has increased in recent years. Enhanced recovery (ER) protocols are associated with improved outcomes, such as decreased length of stay (LOS). We examined the impact of MIS and ER protocols on outcomes after rectal resection for neoplasm. METHODS: A retrospective analysis was performed for patients undergoing elective open (OS) or MIS rectal resection for neoplasm from 2010 to 2015 at a single institution. MIS was defined as any laparoscopic or robotic procedure. An ER protocol was implemented in 8/2013. Regression models were used to estimate outcomes including LOS, 30-day morbidity, readmission, and hospital costs. RESULTS: Among 325 patients, 252 (77.5%) underwent OS; 73 (22.5%) underwent MIS rectal resection. Prior to ER implementation, only 6.1% underwent MIS, compared to 23.1 and 54.4% in the 2 years following ER implementation (p < 0.001). Prior to ER implementation, median LOS was 7 days (n = 181) with 23.8% 30-day morbidity. Following ER implementation, median LOS was 4 days (n = 144); patients receiving OS had median LOS of 5.5 days (n = 82) and 30-day morbidity of 19.5%. ER patients receiving MIS had median LOS of 3 days (n = 62) and 30-day morbidity of 14.5%. Univariate regression demonstrated that MIS patients on ER protocol were more likely to have a shortened LOS (< 6 days) compared to OS patients on non-ER protocol (both p < 0.001). CONCLUSIONS: The combination of MIS and ER protocol is significantly associated with reduced LOS for patients undergoing rectal resection for neoplasm. Further research is needed to determine which patients are best suited to MIS from an oncologic standpoint.
BACKGROUND: Minimally invasive surgery (MIS) for rectal cancer has increased in recent years. Enhanced recovery (ER) protocols are associated with improved outcomes, such as decreased length of stay (LOS). We examined the impact of MIS and ER protocols on outcomes after rectal resection for neoplasm. METHODS: A retrospective analysis was performed for patients undergoing elective open (OS) or MIS rectal resection for neoplasm from 2010 to 2015 at a single institution. MIS was defined as any laparoscopic or robotic procedure. An ER protocol was implemented in 8/2013. Regression models were used to estimate outcomes including LOS, 30-day morbidity, readmission, and hospital costs. RESULTS: Among 325 patients, 252 (77.5%) underwent OS; 73 (22.5%) underwent MIS rectal resection. Prior to ER implementation, only 6.1% underwent MIS, compared to 23.1 and 54.4% in the 2 years following ER implementation (p < 0.001). Prior to ER implementation, median LOS was 7 days (n = 181) with 23.8% 30-day morbidity. Following ER implementation, median LOS was 4 days (n = 144); patients receiving OS had median LOS of 5.5 days (n = 82) and 30-day morbidity of 19.5%. ER patients receiving MIS had median LOS of 3 days (n = 62) and 30-day morbidity of 14.5%. Univariate regression demonstrated that MIS patients on ER protocol were more likely to have a shortened LOS (< 6 days) compared to OSpatients on non-ER protocol (both p < 0.001). CONCLUSIONS: The combination of MIS and ER protocol is significantly associated with reduced LOS for patients undergoing rectal resection for neoplasm. Further research is needed to determine which patients are best suited to MIS from an oncologic standpoint.
Authors: Robert H Thiele; Kathleen M Rea; Florence E Turrentine; Charles M Friel; Taryn E Hassinger; Timothy L McMurry; Bernadette J Goudreau; Bindu A Umapathi; Irving L Kron; Robert G Sawyer; Traci L Hedrick Journal: J Am Coll Surg Date: 2015-01-09 Impact factor: 6.113
Authors: Puja M Shah; Lily Johnston; Bethany Sarosiek; Amy Harrigan; Charles M Friel; Robert H Thiele; Traci L Hedrick Journal: Dis Colon Rectum Date: 2017-02 Impact factor: 4.585
Authors: Pierre J Guillou; Philip Quirke; Helen Thorpe; Joanne Walker; David G Jayne; Adrian M H Smith; Richard M Heath; Julia M Brown Journal: Lancet Date: 2005 May 14-20 Impact factor: 79.321
Authors: Quintín H González; Homero A Rodríguez-Zentner; J Manuel Moreno-Berber; Omar Vergara-Fernández; Héctor Tapia-Cid de León; Luis A Jonguitud; Roberto Ramos; J Andrés Moreno-López Journal: Am Surg Date: 2009-01 Impact factor: 0.688
Authors: Taryn E Hassinger; J Hunter Mehaffey; Allison N Martin; Kristine Bauer-Nilsen; Florence E Turrentine; Robert H Thiele; Bethany M Sarosiek; Matthew J Reilley; Sook C Hoang; Charles M Friel; Traci L Hedrick Journal: Dis Colon Rectum Date: 2019-11 Impact factor: 4.585