In stage II/III rectal carcinoma, minimally invasive surgery offers good outcomes

  • Lee GC & al.
  • Surg Endosc
  • 16 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A retrospective analysis finds that minimally invasive surgery (MIS) is associated with better safety and survival outcomes than open resection in stage II/III rectal cancer.

Why this matters

  • Randomized controlled trials examining open vs minimally invasive techniques in rectal cancer have produced mixed results.

Study design

  • Retrospective analysis of the National Cancer Database from 2010 to 2015 (N=31,190).
  • Funding: NIH.

Key results

  • 52.8% of cases were open, 47.2% MIS (laparoscopic, 26.2%; laparoscopic converted to open, 4.8%; robotic, 15.0%; robotic converted to open, 1.2%).
  • 15.6% of laparoscopic and 7.4% of robotic procedures converted to open.
  • After adjustment for patient, tumor, and institutional characteristics, MIS was associated with:
    • Lower risk for positive circumferential resection margins: OR, 0.82 (P=.003).
    • Greater probability of 12 or more lymph nodes harvested: OR, 1.12 (P=.004).
  • MIS also was linked to:
    • Lower probability of a ≥7-day hospital stay (P<.001>
    • Better OS (HR, 0.90; P=.01).
  • However, MIS was associated with an increased frequency of unplanned readmission: OR, 1.16 (P=.03).
  • Subset analyses of MIS procedures converted to open procedures revealed no association with rates of positive circumferential margin, length of stay, 30-day mortality, or 90-day mortality (compared with open procedures).

Limitations

  • Retrospective analysis.