Esther H Cha, MD1, David Blitzer, MD1, Kevin Izquierdo, MD2, John H Marks, MD2. 1Medstar Union Memorial Hospital, 2Lankenau Medical Center
Introduction: There are limited published data on current national trends and adoption of minimally invasive low anterior resections (LAR) for rectal cancer patients. The objective of this study is to track inpatient outcome, hospital charges, and discharge disposition as a function of open and minimally invasive surgical techniques for LAR.
Methods and Procedures: The National Inpatient Sample was searched for all patients from 2009 to 2013 with a primary diagnosis of rectal cancer (ICD-9: 154.1) who underwent elective open, laparoscopic or robotic LAR (ICD-9: 48.62, 48.63, 54.21, 54.51, 17.39, 17.42, and 17.49) excluding anal cancer (ICD-9: 154.2, 154.3) or concurrent recto-sigmoid cancer (ICD-9: 154.0, 154.8). Minimally invasive surgical approach (MIS) LAR was defined as having both laparoscopic and robotic codes. These dates were chosen because coding methods prior to 2008 underrepresented MIS procedures and new robotic codes were not introduced until mid 2008. Data recorded included age, gender, mortality, morbidity, length of stay (LOS), diagnosis and procedure codes. Results were analyzed using Chi2 and weighted t-test.
Results: A total of 13,464 patients with rectal cancer who underwent elective LAR were included in this study. Of these, 11,807 cases were open LAR (87.6%), 1,657 cases were both laparoscopic and robotic LAR (12.3%), and 806 cases were robotic LAR (5.9%). Mean age for open, MIS and robotic LAR were: 60 (SD 12.4), 59 (SD 12.1), and 58 (SD 11.1). 62% were male for robotic LAR. Mean LOS for open, MIS and robotic LAR were 6.1, 5.6, and 4.6 days. When comparing MIS with open LAR, there were no significant differences in the mortality, morbidity and LOS. Similarly, there were no significant differences in mortality and morbidity for robotic LAR compared to open approach. However, length of stay for robotic LAR was shorter when compared to open approach (7 versus 8 days; p = 0.03).
Conclusion: Rectal cancer patients undergoing elective open, MIS or robotic LAR had similar morbidity and mortality. Robotic LAR patients had a significant shorter hospital stay. These national trends reflect potential underutilization of robotic surgery pertaining to rectal cancer therapy. Future studies should identify factors that will optimize outcomes of robotic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87856
Program Number: S050
Presentation Session: Robotics 1 Session
Presentation Type: Podium