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A Comparison of Pathologic Outcomes of Open, Laparoscopic, and Robotic Resections for Rectal Cancer Using the ACS-NSQIP Proctectomy-Targeted Database: a Propensity Score Analysis

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgments

Laurent Azoulay is the recipient of a Chercheur-Boursier award from the Fonds de Recherche du Quebec–Santé and a William Dawson Scholar award from McGill University.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, G-317, Montreal, Quebec, H3T 1E2, Canada

    Richard Garfinkle, Maria Abou-Khalil, Nathalie Wong-Chong, Nancy Morin, Carol-Ann Vasilevsky & Marylise Boutros

  2. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada

    Sahir Bhatnagar & Laurent Azoulay

  3. Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada

    Laurent Azoulay

  4. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada

    Laurent Azoulay

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  1. Richard Garfinkle
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  2. Maria Abou-Khalil
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Contributions

RG, MAK, SB, NWC, LA, NM, CAV and MB have all met the following criteria for authorship:

-Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work, and

-Drafting the work or revising it critically for important intellectual content; and

-Final approval of the version to be published, and

-Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Marylise Boutros.

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The authors declare that they have no conflict of interest.

Additional information

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the 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 authors.

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Garfinkle, R., Abou-Khalil, M., Bhatnagar, S. et al. A Comparison of Pathologic Outcomes of Open, Laparoscopic, and Robotic Resections for Rectal Cancer Using the ACS-NSQIP Proctectomy-Targeted Database: a Propensity Score Analysis. J Gastrointest Surg 23, 348–356 (2019). https://doi.org/10.1007/s11605-018-3974-8

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