M. I. Orloff1, J. Lu1, S. Kolakowski1, D. Vyas1, A. Dayama1 1San Joaquin General Hospital,Surgery,French Camp, CA, USA
Introduction: Surgical resection with curative intent is the cornerstone of treatment of colorectal cancer. In this study, we sought to compare oncologic and 30-day perioperative outcomes following open, laparoscopic and robotic low anterior resection (LAR) without diverting ostomy for colorectral cancer.
Methods: We reviewed the ACS-NSQIP targeted colectomy database from 2014-2016 to identify patients who underwent LAR. We excluded non-cancerous pathology, LAR with diverting ostomy, hybrid operative approaches, and patients with missing data on anastomotic leak and lymph nodes harvested. Primary outcomes were margin status, number of lymph nodes harvested, anastomotic leak and 30-day mortality. Multivariate analysis was used to determine the association between operation approach, anastomotic leak, and mortality.
Results:A total of 5,367 patients met our inclusion criteria – 2119 underwent open LAR, 2432 underwent laparoscopic LAR and 816 underwent robotic LAR. There was no difference in the average number of nodes harvested (19.1 open, 19.7 laparoscopic, 20.0 robotic, P 0.06) (Table 1A). There were no cases of positive margins in any of the patients. Operative time was greater in robotic LAR compared to laparoscopic and open surgeries (open 215 minutes (mins), laparoscopic, 219 mins, robotic 266 mins, P < 0.01). Length of stay was greater in open LAR (open 7.9 days (d), laparoscopic 5.1 d, robotic 5.0 d, P < 0.01). There was no difference in rates of anastomotic leak (open 4.7%, laparoscopic 3.7%, robotic 5.4%, P 0.06) (Table 1B). Laparoscopic and robotic LAR was associated with significantly lower mortality, compared to open (open 1.4%, laparoscopic 0.5%, robotic 0.1%, p < 0.01). On multivariate analysis, there was no association between operative technique and anastomotic leak (Table 1c). Multivariate analysis showed that laparoscopic LAR was associated with a statistically lower mortality compared to open LAR (OR 0.42, CI 0.20 – 0.87).
Conclusion: Review of a contemporary national database reveals equivalent oncologic outcomes among patients who undergo open, laparoscopic and robotic LAR for colorectal cancer. However, laparoscopic and robotic LAR are associated with less postoperative morbidity, shorter length of stay and lower mortality.
