Azah Althumairi, MD, James P Taylor, MBBChir, MPH, Miloslawa Stem, MS, Susan L Gearhart, MD, Sandy Fang, MD, Chady Atallah, Bashar Safar, MD, Jonathan Efron, MD. Johns Hopkins
INTRODUCTION: Prior randomized trials showed comparable short-term outcomes between open and minimally invasive proctectomy (OP and MIP) for rectal cancer. We hypothesize that short-term outcomes for MIP have improved as surgeons have become more experienced with this technique over time.
METHODS AND PROCEDURES: Retrospective cohort study of rectal cancer patients who underwent elective proctectomy using the proctectomy-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2016 database. Patients were stratified into three groups based on intent-to-treat protocol: OP, MIP, and hybrid proctectomy (HP). Multivariable logistic regression analysis was used to assess the impact of operative approach on 30-day overall morbidity. Subgroup analysis for laparoscopic and robotic proctectomy (LP and RP) patients was also performed.
RESULTS: 1,781 procedures were performed (42.78% OP, 34.59% MIP [58.77% LP, 41.23% RP], and 22.63% HP). MIP and HP patients had less comorbidities and their overall morbidity rates were significantly lower for patients who underwent MIP and HP (36.88% vs. 26.95% vs. 20.84%, respectively; p<0.001) (TABLE). Clavien-Dindo III-V complications, readmission, reoperation, and anastomotic leak rates were comparable between OP and MIP. OP patients had significantly longer hospital length of stay (LOS) (7 vs. 5 days for MIP and HP, p<0.001). Interestingly, HP patients had significantly lower rates of overall morbidity, organ space SSI, anastomotic leak, Clavien-Dindo III-V complication, and shorter operative time when compared to the MIP patients. There was no significant difference in overall morbidity between RP and LP patients (29.01% vs. 24.02%, p=0.169). Adjusted analysis showed similar results with MIP and HP having significantly decreased odds of overall morbidity in comparison to OP (OR 0.68, 95% CI 0.53-0.86; OR 0.48, 95% CI 0.36-0.65; both p<0.001), and RP being equivalent with LP in terms of overall morbidity (OR 0.80, 95% CI 0.54-1.17, p=0.243).
CONCLUSIONS: Patients selected to undergo MIP had significantly better overall morbidity rates and shorter LOS when compared with patients who underwent OP. Appropriate selection of patients for MIP can result in better outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95133
Program Number: P366
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster