D. T. Thompson1, P. Goffredo1, A. F. Utria1, I. Gribovskaja-Rupp1, J. Hrabe1, M. R. Kapadia1, I. Hassan1 1University Of Iowa,Iowa City, IA, USA
Introduction:
Laparoscopic and robotic platforms are commonly utilized minimally invasive approaches to perform abdominoperineal resections (APR) for rectal cancer (RC). There is however limited empiric evidence regarding the comparative effectiveness of these techniques with or without open assistance (OA). We hypothesized that in selected patients, differing minimally invasive approaches would not impact short-term outcomes. We therefore analyzed characteristics and perioperative outcomes of patients undergoing laparoscopic and robotic APR with or without OA for RC using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database Proctectomy Targeted Participant Use File (PUF).
Methods:
CPT code 45395 was used to identify patients from the 2016 ACS-NSQIP Proctectomy PUF database. Patients were analyzed if based on NSQIP definitions they underwent elective laparoscopic, robotic, laparoscopic with OA, or robotic with OA APR for RC. Patient disease and treatment characteristics, operation time (OT), length of stay (LOS), and perioperative clinical outcomes along with lymph node harvest (LNH) and circumferential margin (CRM) status were compared. Analyses were performed using chi-square tests, Fisher’s Exact tests, Student’s t-tests, Mann-Whitney U tests, and one-way ANOVA.
Results:
We identified 412 patients of which 128 (31%) were laparoscopic, 116 (28%) robotic, 107 (26%) laparoscopic with OA, and 61 (15%) robotic with OA. The characteristics of the cohort were as follows: mean age 65±13 years, 65% males, median BMI 28 kg/m2 (range 16-53), ASA ≥ 3 60%, neoadjuvant therapy 66%, locally advanced cancer 64%, and distal third of rectum tumor location 70%. There were no significant differences across the four groups for these variables (all p>0.05). Two-thirds of patients did not have complications and there were no reported mortalities. Short-term perioperative and measured oncologic outcomes were similar between groups (Table 1). A comparison of laparoscopic and robotic vs. OA approaches did not show a significant difference in LOS (median 6 vs. 6 days), OT (300 vs. 290 minutes), CRM (9% vs. 7% positive), LNH (16 vs. 16 nodes), or Clavien-Dindo grade ≥ 3 complications (7% vs. 7% positive) (all p>0.05).
Conclusion:
Patients undergoing laparoscopic or robotic APR are well selected and experience similar short-term clinical and oncologic outcomes regardless of minimally invasive technique. Further investigation into long term results is essential. Ultimately, surgeon preference and experience as well as system resources likely dictate which approach to utilize for APR in patients with rectal cancer.
