N.R. Suss1, K.M. Kuchta2, S.B. Hays1, B.D. Shogan1, M.S. Talamonti2, M.E. Hogg2 1University Of Chicago, Surgery, Chicago, IL, USA 2Northshore University Health System, Surgery, Evanston, IL, USA
Introduction:
Different colorectal cancer (CRC) histologies have unique characteristics which impact tumor growth rate and depth of invasion. While large colorectal adenocarcinomas (AC) have been shown to have improved outcomes with minimally invasive surgery (MIS), it is unknown if such benefits extend to CRC of different histologies. Here we investigated the clinical factors and outcomes associated with utilizing MIS for colorectal AC, gastrointestinal stromal tumors (GISTs), and neuroendocrine tumors (NETs) >5cm.
Methods:
The National Cancer Database was queried for colorectal GISTs, NETs, and AC tumors >5cm that underwent open or MIS resection from 2010-2021. Given the challenge of resection of large distal tumors, rectal resections were stratified into proximal (LAR, sigmoidectomy) vs distal (APR). Multivariable analyses (MVA) were performed to assess the impact of the MIS approach on length of stay (LOS) >7 days, 30-day readmission, and 30- and 90-day mortality. Cox regression and Kaplan-Meier survival analyses were performed to analyze differences in overall survival (OS) between the two approaches.
Results:
50,550 patients were identified with AC, GIST, or NET >5cm of the rectum (44% open, 56% MIS), and 196,379 patients were identified for colon (48% open, 52% MIS). An open approach was used more often in distal rectal resections (31.6% vs 24.0%, p,0.01), while the MIS approach was used more often in high volume centers (rectal: 66.0% vs 58.8%, p<.01; colon: 54.6% vs 46.0%, p<.01). On MVA, rectal GISTs were less likely than AC to undergo MIS, whereas colonic NETs were more likely to undergo MIS than AC. MIS approach significantly decreased the risk of hospital LOS >7 days, 30-day readmission, and 30- and 90-day mortality for both colon and rectal tumors of all histologies. On Kaplan-Meier analysis, MIS vs open for rectal tumors demonstrated a 5-year survival benefit (70% vs 59.1%, p<.001, Figure 1a) for all tumor histologies; this persisted for AC (p<.001) and NET (p=.004). MIS vs open for colon tumors similarly demonstrated a 5-year survival benefit (62.6% vs 49.4%, p<.001, Figure 1b) for all tumor types; this persisted across all tumor histology types (p<.001). Cox regression identified a significant survival benefit to MIS vs open for rectal (HR 0.73) and colon (HR 0.70) tumors of all histology types.
Conclusion:
MIS for colorectal AC, GISTs, and NETs >5cm results in decreased LOS, 30-day readmission, and 30- and 90-day mortality with a significant improvement in 5-year OS. MIS represents a safe and beneficial approach for the resection of colorectal AC, GISTs, and NETs >5cm.