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Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity

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Abstract

Background

Prior randomized trials showed comparable short-term outcomes between open and minimally invasive proctectomy (MIP) for rectal cancer. We hypothesize that short-term outcomes for MIP have improved as surgeons have become more experienced with this technique.

Methods

Rectal cancer patients who underwent elective abdominoperineal resection (APR) or low anterior resection (LAR) were included from the American College of Surgeons National Surgical Quality Improvement Program database (2016–2018). Patients were stratified based on intent-to-treat protocol: open (O-APR/LAR), laparoscopic (L-APR/LAR), robotic (R-APR/LAR), and hybrid (H-APR/LAR). Multivariable logistic regression analysis was used to assess the impact of operative approach on 30-day morbidity.

Results

A total of 4471 procedures were performed (43.41% APR and 36.59% LAR); O-APR 42.72%, L-APR 20.99%, R-APR 16.79%, and H-APR 19.51%; O-LAR 31.48%, L-LAR 26.34%, R-LAR 17.48%, and H-LAR 24.69%. Robotic APR and LAR were associated with shortest length of stay and significantly lower conversion rate. After adjusting for other factors, lap, robotic and hybrid APR and LAR were associated with decreased risk of overall morbidity when compared to open approach. R-APR and H-APR were associated with decreased risk of serious morbidity. No difference in the risk of serious morbidity was observed between the four LAR groups.

Conclusion

Appropriate selection of patients for MIP can result in better short-term outcomes, and consideration for MIP surgery should be made.

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Acknowledgements

Mr. Edwin Lewis has provided generous support for Dr. Efron’s Department of Surgery Research Fund.

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Authors and Affiliations

  1. Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, School of Medicine, Johns Hopkins University, 733 North Broadway, Suite 101, Baltimore, MD, 21205, USA

    James P. Taylor, Miloslawa Stem, Azah A. Althumairi, Susan L. Gearhart, Bashar Safar, Sandy H. Fang & Jonathan E. Efron

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  1. James P. Taylor
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Correspondence to Jonathan E. Efron.

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Taylor, J.P., Stem, M., Althumairi, A.A. et al. Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity. World J Surg 44, 3130–3140 (2020). https://doi.org/10.1007/s00268-020-05560-9

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  • DOI: https://doi.org/10.1007/s00268-020-05560-9

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