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Evolution of minimally invasive surgery for rectal cancer: update from the national cancer database

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Abstract

Background

As the use of minimally invasive techniques in colorectal surgery has become increasingly prevalent, concerns remain about the oncologic effectiveness and long-term outcomes of minimally invasive low anterior resection (MI-LAR) for the treatment of rectal cancer.

Study design

The 2010–2015 National Cancer Database (NCDB) Participant Data Use File was queried for patients undergoing elective open LAR (OLAR) or MI-LAR for rectal adenocarcinoma. A 1:1 propensity match was performed on the basis of demographics, comorbidity, and tumor characteristics. Outcomes were compared between groups and Cox proportional hazard modeling was performed to identify independent predictors of mortality. A subset analysis was performed on high-volume academic centers.

Results

35,809 patients undergoing LAR were identified of whom 18,265 (51.0%) underwent MI-LAR. After propensity matching, patients receiving MI-LAR were less likely to have a positive circumferential radial margin (CRM) (5.5% vs. 6.6%, p = 0.0094) or a positive distal margin (3.6% vs. 4.6%, p = 0.0022) and had decreased 90-day all-cause mortality (2.0% vs. 2.6%, p = 0.0238). MI-LAR resulted in decreased hospital length of stay (5 vs. 6 days, p < 0.0001) but a greater rate of 30-day readmission (7.6% vs. 6.5%, p = 0.0054). Long-term overall survival was improved with MI-LAR (79% vs. 76%, p < 0.0001). Cox proportional hazard modeling demonstrated a decreased risk of mortality with MI-LAR (HR 0.859, 95% CI 0.788–0.937).

Conclusion

MI-LAR is associated with improvement in CRM clearance and long-term survival. In the hands of experienced surgeons with advanced laparoscopy skills, MI-LAR appears safe and effective technique for the management of rectal cancer.

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Authors and Affiliations

  1. Department of Surgery, Duke University, Durham, NC, USA

    Brian Gilmore, Mohamed A. Adam, Kristen Rhodin, Megan C. Turner, Brian Ezekian, Christopher R. Mantyh & John Migaly

  2. Duke University Medical Center, Box 3443, Durham, NC, 27710, USA

    Brian Gilmore

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  1. Brian Gilmore
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  2. Mohamed A. Adam
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Correspondence to Brian Gilmore.

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Disclosures

Brian Gilmore, Mohamed A. Adam, Kristen Rhodin, Megan C. Turner, Brian Ezekian, Christopher R. Mantyh, John Migaly have no financial ties or conflicts of interest to disclose.

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NCDB Provision Disclosure: The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the author.

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Gilmore, B., Adam, M.A., Rhodin, K. et al. Evolution of minimally invasive surgery for rectal cancer: update from the national cancer database. Surg Endosc 35, 275–290 (2021). https://doi.org/10.1007/s00464-020-07393-y

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  • DOI: https://doi.org/10.1007/s00464-020-07393-y

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