Background
Although evidence to support the use of laparoscopic and robotic approaches for the
treatment of rectal cancer is limited, these approaches are being adopted broadly.
We sought to investigate national practice patterns and compare short-term oncologic
outcomes of different approaches for rectal cancer resections.
Methods
The 2010 National Cancer Database was queried for operative cases of rectal cancer.
Approach was classified as open, laparoscopic, or robotic. Patient, tumor, and hospital
characteristics and surgical margin status were evaluated. Propensity score matching
was used to compare outcomes across approaches.
Results
We identified 8,712 patients. Laparoscopic and robotic approaches were more common
in privately insured and wealthier patients at high-volume centers (P < .001). Open approaches were used for tumors with higher histologic grade and pathologic
stage (P < .001). A minimally invasive approach was associated with fewer positive margins
and shorter hospital stays. After propensity score matching, the laparoscopic approach
was associated with a 2.0% lesser (P = .01) and robotic surgery with a 3.8% lesser (P = .004) incidence of positive margins compared with open surgery.
Conclusion
An open approach is often used in rectal cancers with higher pathologic stages. Matched
patient analysis suggests minimally invasive approaches are associated with improved
R0 resections.
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Article info
Publication history
Published online: May 18, 2015
Accepted:
February 15,
2015
Footnotes
Source of Funding: No funding was used for this research.
The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
