Salvatore A Parascandola1,2, Salini Hota3, Andrew D Sparks4, Sameh Boulos5, Kathryn Cavallo5, George Kim6, Vincent Obias6. 1. Walter Reed National Military Medical Center, Bethesda, MD, USA. salvatore.parascandola@gmail.com. 2. C/O Medical Faculty Associates, Walter Reed National Military Medical Center, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA. salvatore.parascandola@gmail.com. 3. Eastern Virginia Medical School, Norfolk, VA, USA. 4. Department of Surgery, George Washington University Medical Faculty Associates, Washington, DC, USA. 5. George Washington University School of Medicine and Health Sciences, Washington, DC, USA. 6. George Washington University Hospital, Washington, DC, USA.
Abstract
BACKGROUND: This study examined utilization and conversion rates for robotic and laparoscopic approaches to non-metastatic rectal cancer. Secondary aims were to examine short- and long-term outcomes of patients who underwent conversion to laparotomy from each approach. METHODS: The National Cancer Database (NCDB) was reviewed for all cases of non-metastatic adenocarcinoma of the rectum or rectosigmoid junction who underwent surgical resection from 2010 to 2016. Utilization rates of robotic, laparoscopic, and open approaches were examined. Patients were split into cohorts by approach. Subgroup analyses were performed by primary tumor site and surgical procedure. Multivariable analysis was performed by multivariable logistic regression for binary outcomes and multivariable general linear models for continuous outcomes. Survival analysis was performed by Kaplan-Meier and multivariable cox-proportional hazards regression. RESULTS: From 2010 to 2016, there was a statistically significant increase in utilization of the robotic and laparoscopic approaches over the study period and a statistically significant decrease in utilization of the open approach. The conversion rates for robotic and laparoscopic cohorts were 7.0% and 15.7%, p < 0.0001. Subgroup analysis revealed statistically lower conversion rates between robotic and laparoscopic approaches for rectosigmoid and rectal tumors and for LAR and APR. Converted cohorts had statistically significant higher odds of short term mortality than the non-converted cohorts (p < 0.05).Laparoscopic conversion had statistically higher odds of positive margins (p < 0.0001) and 30-day unplanned readmission (p < 0.0001) than the laparoscopic non-conversion. Increased adjusted mortality hazard was seen for converted laparoscopy relative to non-converted laparoscopy (p = 0.0019). CONCLUSION: From 2010 to 2016, there was a significant increase in utilization of minimally invasive approaches to surgical management of non-metastatic rectal cancer. A robotic approach demonstrated decreased conversion rates than a laparoscopic approach at the rectosigmoid junction and rectum and for LAR and APR. Improved outcomes were seen in the minimally invasive cohorts compared to those that converted to laparotomy.
BACKGROUND: This study examined utilization and conversion rates for robotic and laparoscopic approaches to non-metastatic rectal cancer. Secondary aims were to examine short- and long-term outcomes of patients who underwent conversion to laparotomy from each approach. METHODS: The National Cancer Database (NCDB) was reviewed for all cases of non-metastatic adenocarcinoma of the rectum or rectosigmoid junction who underwent surgical resection from 2010 to 2016. Utilization rates of robotic, laparoscopic, and open approaches were examined. Patients were split into cohorts by approach. Subgroup analyses were performed by primary tumor site and surgical procedure. Multivariable analysis was performed by multivariable logistic regression for binary outcomes and multivariable general linear models for continuous outcomes. Survival analysis was performed by Kaplan-Meier and multivariable cox-proportional hazards regression. RESULTS: From 2010 to 2016, there was a statistically significant increase in utilization of the robotic and laparoscopic approaches over the study period and a statistically significant decrease in utilization of the open approach. The conversion rates for robotic and laparoscopic cohorts were 7.0% and 15.7%, p < 0.0001. Subgroup analysis revealed statistically lower conversion rates between robotic and laparoscopic approaches for rectosigmoid and rectal tumors and for LAR and APR. Converted cohorts had statistically significant higher odds of short term mortality than the non-converted cohorts (p < 0.05).Laparoscopic conversion had statistically higher odds of positive margins (p < 0.0001) and 30-day unplanned readmission (p < 0.0001) than the laparoscopic non-conversion. Increased adjusted mortality hazard was seen for converted laparoscopy relative to non-converted laparoscopy (p = 0.0019). CONCLUSION: From 2010 to 2016, there was a significant increase in utilization of minimally invasive approaches to surgical management of non-metastatic rectal cancer. A robotic approach demonstrated decreased conversion rates than a laparoscopic approach at the rectosigmoid junction and rectum and for LAR and APR. Improved outcomes were seen in the minimally invasive cohorts compared to those that converted to laparotomy.
Authors: Rosa M Jiménez-Rodríguez; Mercedes Rubio-Dorado-Manzanares; José Manuel Díaz-Pavón; M Luisa Reyes-Díaz; Jorge Manuel Vazquez-Monchul; Ana M Garcia-Cabrera; Javier Padillo; Fernando De la Portilla Journal: Int J Colorectal Dis Date: 2016-10-06 Impact factor: 2.571
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: James Fleshman; Megan Branda; Daniel J Sargent; Anne Marie Boller; Virgilio George; Maher Abbas; Walter R Peters; Dipen Maun; George Chang; Alan Herline; Alessandro Fichera; Matthew Mutch; Steven Wexner; Mark Whiteford; John Marks; Elisa Birnbaum; David Margolin; David Larson; Peter Marcello; Mitchell Posner; Thomas Read; John Monson; Sherry M Wren; Peter W T Pisters; Heidi Nelson Journal: JAMA Date: 2015-10-06 Impact factor: 56.272
Authors: Francesco Paolo Prete; Angela Pezzolla; Fernando Prete; Mario Testini; Rinaldo Marzaioli; Alberto Patriti; Rosa Maria Jimenez-Rodriguez; Angela Gurrado; Giovanni F M Strippoli Journal: Ann Surg Date: 2018-06 Impact factor: 12.969
Authors: David Jayne; Alessio Pigazzi; Helen Marshall; Julie Croft; Neil Corrigan; Joanne Copeland; Phil Quirke; Nick West; Tero Rautio; Niels Thomassen; Henry Tilney; Mark Gudgeon; Paolo Pietro Bianchi; Richard Edlin; Claire Hulme; Julia Brown Journal: JAMA Date: 2017-10-24 Impact factor: 56.272
Authors: Marco E Allaix; Edgar J B Furnée; Massimiliano Mistrangelo; Alberto Arezzo; Mario Morino Journal: World J Gastroenterol Date: 2016-10-07 Impact factor: 5.742
Authors: M Maspero; M Mazzola; C L Bertoglio; J Crippa; L Morini; C Magistro; P De Martini; M Gualtierotti; P M Lombardi; G Ferrari Journal: Br J Surg Date: 2020-08-05 Impact factor: 6.939
Authors: T Matsuyama; H Endo; H Yamamoto; I Takemasa; K Uehara; T Hanai; H Miyata; T Kimura; H Hasegawa; Y Kakeji; M Inomata; Y Kitagawa; Y Kinugasa Journal: BJS Open Date: 2021-09-06
Authors: Enda Hannan; Gerard Feeney; Mohammad Fahad Ullah; Eoghan Condon; John Calvin Coffey; Colin Peirce Journal: Int J Med Robot Date: 2022-06-26 Impact factor: 2.483