Joshua Dilday, DO, Shaun Brown, DO, Paul Sanders, MD, Eric Ahnfeldt, DO. William Beaumont Army Medical Center
Introduction: The purpose of this study was to evaluate the current application of minimally invasive surgery and compare the 30-day postoperative complications following open vs. laparoscopic APR for cancer.
Methods: The 2014 ACS NSQIP database was utilized for this study. Patients that underwent an APR for rectal or anal cancer were included in the analysis. Patients were then grouped based on operative approach into an open (CPT code 45110) or laparoscopic group (CPT code 45395). Patient demographic information, preoperative laboratory data, postoperative complications and mortality were compared between groups. Statistical analysis was performed utilizing unpaired t-test and chi square analysis. Statistical significance was defined as p<0.05.
Results: A total of 1450 patients who underwent an APR for cancer were included, 549 (38%) in the laparoscopic group and 901 (62%) in the open group. The preoperative demographic data was similar between groups. There was no difference between the groups in regards to superficial SSI, wound dehiscence, readmission, or mortality (table 1). Open APR was associated with a longer LOS (10.5 days vs. 7.7 days, p<0.0001), a higher rate of organ space SSI (8% vs. 3%, p=0.0005), more blood transfusions (24% vs. 9%, p<0.0001), and more frequent return to the OR (9% vs. 6%, p=0.027). Additionally, the open group had a higher rate of pulmonary complications such as, pneumonia (4% vs. 1.5%, p=0.0021), reintubation (2% vs. 0.5%, p=0.024), and prolonged intubation (2% vs. 0.3%, p=0.025).
Conclusion: In the era of minimally invasive surgery the majority of patients received an open APR for treatment of their rectal or anal cancer. However, laparoscopic APR resulted in significantly less postoperative complications, shorter LOS, less need for transfusion, and a lower rate of reoperation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78834
Program Number: P241
Presentation Session: Poster (Non CME)
Presentation Type: Poster