Richard Garfinkle1, Maria Abou-Khalil1, Sahir Bhatnagar2, Nathalie Wong-Chong1, Laurent Azoulay2,3,4, Nancy Morin1, Carol-Ann Vasilevsky1, Marylise Boutros5. 1. Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, G-317, Montreal, Quebec, H3T 1E2, Canada. 2. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada. 3. Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada. 4. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada. 5. Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, G-317, Montreal, Quebec, H3T 1E2, Canada. mboutros@jgh.mcgill.ca.
Abstract
BACKGROUND: There is ongoing debate regarding the benefits of minimally invasive techniques for rectal cancer surgery. The aim of this study was to compare pathologic outcomes of patients who underwent rectal cancer resection by open surgery, laparoscopy, and robotic surgery using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) proctectomy-targeted database. METHODS: All patients from the 2016 ACS-NSQIP proctectomy-targeted database who underwent elective proctectomy for rectal cancer were identified. Patients were divided into three groups based on initial operative approach: open surgery, laparoscopy, and robotic surgery. Pathologic and 30-day clinical outcomes were then compared between the groups. A propensity score analysis was performed to control for confounders, and adjusted odds ratios for pathologic outcomes were reported. RESULTS: A total of 578 patients were included-211 (36.5%) in the open group, 213 (36.9%) in the laparoscopic group, and 154 (26.6%) in the robotic group. Conversion to open surgery was more common among laparoscopic cases compared to robotic cases (15.0% vs. 6.5%, respectively; p = 0.011). Positive circumferential resection margin (CRM) was observed in 4.7%, 3.8%, and 5.2% (p = 0.79) of open, laparoscopic, and robotic resections, respectively. Propensity score adjusted odds ratios for positive CRM (open surgery as a reference group) were 0.70 (0.26-1.85, p = 0.47) for laparoscopy and 1.03 (0.39-2.70, p = 0.96) for robotic surgery. CONCLUSIONS: The use of minimally invasive surgical techniques for rectal cancer surgery does not appear to confer worse pathologic outcomes.
BACKGROUND: There is ongoing debate regarding the benefits of minimally invasive techniques for rectal cancer surgery. The aim of this study was to compare pathologic outcomes of patients who underwent rectal cancer resection by open surgery, laparoscopy, and robotic surgery using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) proctectomy-targeted database. METHODS: All patients from the 2016 ACS-NSQIP proctectomy-targeted database who underwent elective proctectomy for rectal cancer were identified. Patients were divided into three groups based on initial operative approach: open surgery, laparoscopy, and robotic surgery. Pathologic and 30-day clinical outcomes were then compared between the groups. A propensity score analysis was performed to control for confounders, and adjusted odds ratios for pathologic outcomes were reported. RESULTS: A total of 578 patients were included-211 (36.5%) in the open group, 213 (36.9%) in the laparoscopic group, and 154 (26.6%) in the robotic group. Conversion to open surgery was more common among laparoscopic cases compared to robotic cases (15.0% vs. 6.5%, respectively; p = 0.011). Positive circumferential resection margin (CRM) was observed in 4.7%, 3.8%, and 5.2% (p = 0.79) of open, laparoscopic, and robotic resections, respectively. Propensity score adjusted odds ratios for positive CRM (open surgery as a reference group) were 0.70 (0.26-1.85, p = 0.47) for laparoscopy and 1.03 (0.39-2.70, p = 0.96) for robotic surgery. CONCLUSIONS: The use of minimally invasive surgical techniques for rectal cancer surgery does not appear to confer worse pathologic outcomes.
Entities:
Keywords:
Database; Laparoscopy; NSQIP; Open surgery; Pathologic outcomes; Proctectomy; Propensity score analysis; Rectal cancer; Robotic surgery
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