Surgical Endoscopy

, Volume 32, Issue 5, pp 2517–2524 | Cite as

Impact of minimally invasive surgery on short-term outcomes after rectal resection for neoplasm within the setting of an enhanced recovery program

  • Allison N. Martin
  • Puja Shah Berry
  • Charles M. Friel
  • Traci L. Hedrick



Minimally invasive surgery (MIS) for rectal cancer has increased in recent years. Enhanced recovery (ER) protocols are associated with improved outcomes, such as decreased length of stay (LOS). We examined the impact of MIS and ER protocols on outcomes after rectal resection for neoplasm.


A retrospective analysis was performed for patients undergoing elective open (OS) or MIS rectal resection for neoplasm from 2010 to 2015 at a single institution. MIS was defined as any laparoscopic or robotic procedure. An ER protocol was implemented in 8/2013. Regression models were used to estimate outcomes including LOS, 30-day morbidity, readmission, and hospital costs.


Among 325 patients, 252 (77.5%) underwent OS; 73 (22.5%) underwent MIS rectal resection. Prior to ER implementation, only 6.1% underwent MIS, compared to 23.1 and 54.4% in the 2 years following ER implementation (p < 0.001). Prior to ER implementation, median LOS was 7 days (n = 181) with 23.8% 30-day morbidity. Following ER implementation, median LOS was 4 days (n = 144); patients receiving OS had median LOS of 5.5 days (n = 82) and 30-day morbidity of 19.5%. ER patients receiving MIS had median LOS of 3 days (n = 62) and 30-day morbidity of 14.5%. Univariate regression demonstrated that MIS patients on ER protocol were more likely to have a shortened LOS (< 6 days) compared to OS patients on non-ER protocol (both p < 0.001).


The combination of MIS and ER protocol is significantly associated with reduced LOS for patients undergoing rectal resection for neoplasm. Further research is needed to determine which patients are best suited to MIS from an oncologic standpoint.


Minimally invasive Enhanced recovery Rectal cancer Surgical outcomes 


Compliance with ethical standards


Allison Martin: salary supported in part by funding support provided by the Institutional National Research Service Award T32 CA 163177 from the National Cancer Institute to A.N.M., Puja Shah Berry, Charles Friel and Traci Hedrick have no conflict of interest or financial ties to disclose.

Supplementary material

464_2017_5956_MOESM1_ESM.docx (86 kb)
Supplementary material 1 (DOCX 86 KB)


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Surgery, Section of Colon and Rectal SurgeryUniversity of VirginiaCharlottesvilleUSA

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