Dakota T Thompson, MD, Paolo Goffredo, MD, Alan F Utria, MD, Jennifer Hrabe, MD, Muneera R Kapadia, MD, Irena Gribovskaja-Rupp, MD, Sajida Ahad, MD, Imran Hassan, MD. University of Iowa
Introduction: Abdominoperineal resections (APR) using laparoscopic and robotic platforms are being increasingly utilized for surgically managing rectal cancer (RC). We hypothesized that laparoscopic and robotic APR would be associated with a shorter length of stay (LOS) and less morbidity compared to open APR. We analyzed demographics and perioperative outcomes of patients undergoing open, laparoscopic and robotic APR for RC using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database Proctectomy Targeted Participant Use File (PUF).
Methods: Patients undergoing an elective APR for RC were identified using CPT codes 45110 and 45395. Patients with CPT 45395 were divided into laparoscopic or robotic APR based on NSQIP definitions. Patient demographics, disease and treatment characteristics, operative time, LOS, and perioperative clinical and oncologic outcomes between approaches were compared.
Results: A total of 787 patients were identified. Age, gender, BMI, neoadjuvant chemoradiotherapy, and preoperative diagnosis of locally advanced cancer were not significantly different between the three approaches (Table). Laparoscopic approach was associated with a lower incidence of positive circumferential radial margin (CRM) and a higher proportion of ≥ 12 lymph node harvest compared to open APR. After adjusting for available confounders, laparoscopic (OR=0.58, CI=0.34-0.97, p=0.040) and robotic approach (OR=0.42, CI=0.24-0.75, p=0.003) was associated with a shorter LOS. However, operative time and Clavien-Dindo complications were not significantly different between approaches.
Conclusion: Laparoscopic and robotic APR for RC are associated with fewer in-hospital days; however, there were no significant differences in perioperative complications. Further investigation into oncologic outcomes is essential to validate the benefit of laparoscopic and robotic APR for RC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95340
Program Number: P343
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster