Top

Published in:

01-09-2020 | Rectal Cancer | Original Scientific Report

Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity

Authors: James P. Taylor, Miloslawa Stem, Azah A. Althumairi, Susan L. Gearhart, Bashar Safar, Sandy H. Fang, Jonathan E. Efron

Published in: World Journal of Surgery | Issue 9/2020

Abstract

Background

Prior randomized trials showed comparable short-term outcomes between open and minimally invasive proctectomy (MIP) for rectal cancer. We hypothesize that short-term outcomes for MIP have improved as surgeons have become more experienced with this technique.

Methods

Rectal cancer patients who underwent elective abdominoperineal resection (APR) or low anterior resection (LAR) were included from the American College of Surgeons National Surgical Quality Improvement Program database (2016–2018). Patients were stratified based on intent-to-treat protocol: open (O-APR/LAR), laparoscopic (L-APR/LAR), robotic (R-APR/LAR), and hybrid (H-APR/LAR). Multivariable logistic regression analysis was used to assess the impact of operative approach on 30-day morbidity.

Results

A total of 4471 procedures were performed (43.41% APR and 36.59% LAR); O-APR 42.72%, L-APR 20.99%, R-APR 16.79%, and H-APR 19.51%; O-LAR 31.48%, L-LAR 26.34%, R-LAR 17.48%, and H-LAR 24.69%. Robotic APR and LAR were associated with shortest length of stay and significantly lower conversion rate. After adjusting for other factors, lap, robotic and hybrid APR and LAR were associated with decreased risk of overall morbidity when compared to open approach. R-APR and H-APR were associated with decreased risk of serious morbidity. No difference in the risk of serious morbidity was observed between the four LAR groups.

Conclusion

Appropriate selection of patients for MIP can result in better short-term outcomes, and consideration for MIP surgery should be made.

Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. https://doi.org/10.1002/bjs.1800691019 CrossRefPubMed

Holder-Murray J, Dozois EJ (2011) Minimally invasive surgery for colorectal cancer: past, present, and future. Int J Surg Oncol. https://doi.org/10.1155/2011/490917 CrossRefPubMedPubMedCentral

National Institutes of Health (1993) Consensus development conference statement on gallstones and laparoscopic cholecystectomy. Am J Surg 165(4):390–398. https://doi.org/10.1016/S0002-9610(05)80929-8

Heikkinen T, Msika S, Desvignes G et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(05)70221-7 CrossRef

van der Pas MHGM, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(13)70016-0 CrossRefPubMed

Matsuyama T, Kinugasa Y, Nakajima Y, Kojima K (2018) Robotic-assisted surgery for rectal cancer: current state and future perspective. Ann Gastroenterol Surg. https://doi.org/10.1002/ags3.12202 CrossRefPubMedPubMedCentral

D’Annibale A, Morpurgo E, Fiscon V et al (2004) Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon Rectum. https://doi.org/10.1007/s10350-004-0711-z CrossRefPubMed

Bonjer HJ, Deijen CL, Abis GA et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. https://doi.org/10.1056/NEJMoa1414882 CrossRefPubMed

Kang CY, Halabi WJ, Luo R et al (2012) Laparoscopic colorectal surgery: a better look into the latest trends. Arch Surg. https://doi.org/10.1001/archsurg.2012.358 CrossRefPubMed

10.

Cadière GB, Himpens J, Germay O et al (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg. https://doi.org/10.1007/s00268-001-0132-2 CrossRefPubMed

11.

Weber PA, Merola S, Wasielewski A et al (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum. https://doi.org/10.1007/s10350-004-7261-2 CrossRefPubMed

12.

Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc Other Interv Tech. https://doi.org/10.1007/s00464-005-0855-5 CrossRef

13.

Siegel R, Cuesta MA, Targarona E et al (2011) Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European association for endoscopic surgery (EAES). Surg Endosc. https://doi.org/10.1007/s00464-011-1805-z CrossRefPubMed

14.

Huang MJ, Liang JL, Wang H et al (2011) Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis. https://doi.org/10.1007/s00384-010-1091-6 CrossRefPubMed

15.

Ng SSM, Lee JFY, Yiu RYC et al (2014) Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials. Ann Surg. https://doi.org/10.1097/SLA.0b013e31828fe119 CrossRefPubMed

16.

Kayano H, Okuda J, Tanaka K et al (2011) Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc. https://doi.org/10.1007/s00464-011-1655-8 CrossRefPubMed

17.

Li X, Wang T, Yao L, Hu L, Jin P, Guo T, Yang K (2017) The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer a meta-analysis and systematic review. Medicine. https://doi.org/10.1097/MD.0000000000007585 CrossRefPubMedPubMedCentral

18.

Prete FP, Pezzolla A, Prete F et al (2017) Robotic versus laparoscopic minimally invasive surgery for rectal cancer. Ann Surg. https://doi.org/10.1097/sla.0000000000002523 CrossRef

19.

Xiong B, Ma L, Zhang C, Cheng Y (2014) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis. J Surg Res. https://doi.org/10.1016/j.jss.2014.01.027 CrossRefPubMed

20.

Crippa J, Grass F, Dozois EJ et al (2020) Robotic surgery for rectal cancer provides advantageous outcomes over laparoscopic approach. Ann Surg. https://doi.org/10.1097/SLA.0000000000003805 CrossRefPubMed

21.

Cui Y, Li C, Xu Z et al (2017) Robot-assisted versus conventional laparoscopic operation in anus-preserving rectal cancer: a meta-analysis. Ther Clin Risk Manag. https://doi.org/10.2147/TCRM.S142758 CrossRefPubMedPubMedCentral

22.

Sun Y, Xu H, Li Z et al (2016) Robotic versus laparoscopic low anterior resection for rectal cancer: a meta-analysis. World J Surg Oncol. https://doi.org/10.1186/s12957-016-0816-6 CrossRefPubMedPubMedCentral

23.

Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol. https://doi.org/10.1200/JCO.2006.09.7758 CrossRefPubMed

24.

Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the medical research council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. https://doi.org/10.1002/bjs.8945 CrossRefPubMed

25.

Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(10)70131-5 CrossRefPubMed

26.

Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(14)70205-0 CrossRefPubMed

27.

ACS user guide for the 2016 ACS national surgical quality improvement program procedure target PUF. https://www.facs.org/~/media/files/qualityprograms/nsqip/pt_nsqip_puf_userguide_2016.ashx Accessed 5 Mar 2020

28.

Henderson WG, Daley J (2009) Design and statistical methodology of the national surgical quality improvement program: why is it what it is? Am J Surg. https://doi.org/10.1016/j.amjsurg.2009.07.025 CrossRefPubMed

29.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205CrossRef

30.

Hosmer DW, Lemeshow S, Sturdivant RX (2013) Applied logistic regression, 3rd edn. John Wiley & Sons, HobokenCrossRef

31.

Shussman N, Wexner SD (2014) Current status of laparoscopy for the treatment of rectal cancer. World J Gastroenterol. https://doi.org/10.3748/wjg.v20.i41.15125 CrossRefPubMedPubMedCentral

32.

Speicher PJ, Englum BR, Ganapathi AM et al (2015) Robotic low anterior resection for rectal cancer: a national perspective on short-term oncologic outcomes. Ann Surg. https://doi.org/10.1097/SLA.0000000000001017 CrossRefPubMedPubMedCentral

33.

Wang Y, Zhao GH, Yang H, Lin J (2016) A pooled analysis of robotic versus laparoscopic surgery for total mesorectal excision for rectal cancer. Surg Laparosc Endosc Percutaneous Tech. https://doi.org/10.1097/SLE.0000000000000263 CrossRef

34.

Sun Z, Kim J, Adam MA et al (2016) Minimally invasive versus open low anterior resection equivalent survival in a national analysis of 14,033 patients with rectal cancer. Ann Surg. https://doi.org/10.1097/SLA.0000000000001388 CrossRefPubMedPubMedCentral

35.

Baik SH, Kwon HY, Kim JS et al (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. https://doi.org/10.1245/s10434-009-0435-3 CrossRefPubMed

36.

Moghadamyeghaneh Z, Phelan M, Smith BR, Stamos MJ (2015) Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer. In: Diseases of the colon and rectum

37.

Jones K, Qassem MG, Sains P et al (2018) Robotic total meso-rectal excision for rectal cancer: a systematic review following the publication of the ROLARR trial. World J Gastrointest Oncol. https://doi.org/10.4251/wjgo.v10.i11.449 CrossRefPubMedPubMedCentral

38.

Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA-J Am Med Assoc. https://doi.org/10.1001/jama.2015.12009 CrossRef

39.

Stevenson ARL, Solomon MJ, Brown CSB et al (2019) Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal cancer. Ann Surg. https://doi.org/10.1097/sla.0000000000003021 CrossRefPubMed

40.

Fitch K, Engel T, Bochner A (2015) Cost differences between open and minimally invasive surgery. Manag Care 24:40PubMed

Title: Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity
Authors: James P. Taylor
Miloslawa Stem
Azah A. Althumairi
Susan L. Gearhart
Bashar Safar
Sandy H. Fang
Jonathan E. Efron
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keywords: Rectal Cancer
Rectal Cancer
Published in: World Journal of Surgery / Issue 9/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05560-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Minimally Invasive Proctectomy for Rectal Cancer: A National Perspective on Short-term Outcomes and Morbidity

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2020

Evolution of the Surgical Residency System in Switzerland: An In-Depth Analysis Over 15 Years

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi-disciplinary Stakeholder Exercise

Transcutaneous Stimulation of Auricular Branch of the Vagus Nerve Attenuates the Acute Inflammatory Response After Lung Lobectomy

Expression of Pancreatic Stone Protein is Unaffected by Trauma and Subsequent Surgery in Burn Patients

Cultural Barriers for Women in Surgery: How Thick is the Glass Ceiling? An Analysis from a Low Middle-Income Country

Effect of Surgical Approach on Node Harvest in Gastrectomy: Analysis of the National Cancer Database