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Minimally Invasive Versus Open Low Anterior Resection

Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer

Sun, Zhifei MD; Kim, Jina MD; Adam, Mohamed A. MD; Nussbaum, Daniel P. MD; Speicher, Paul J. MD; Mantyh, Christopher R. MD; Migaly, John MD

doi: 10.1097/SLA.0000000000001388

Objective: To examine survival of patients who underwent minimally invasive versus open low anterior resection (LAR) for rectal cancer.

Background: Utilization of laparoscopic and robotic LAR for rectal cancer has steadily increased. Short-term outcomes between these techniques and open surgery have shown equivalent results; however, survival outcomes are unknown.

Methods: Adults from the National Cancer Data Base undergoing LAR for rectal adenocarcinoma were identified. Patients were stratified by intent-to-treat into open (OLAR) or minimally invasive LAR (MI-LAR). Multivariable modeling was used to compare short-term outcomes and survival between MI-LAR and OLAR and between laparoscopic (LLAR) and robotic LAR (RLAR).

Results: Among 14,033 patients included, 57.8% underwent OLAR and 42.2% MI-LAR. After adjustment, MI-LAR was associated with shorter length of stay (P < 0.001), but similar rates of positive margins, 30-day readmission, 30-day mortality, and use of adjuvant therapies (all P > 0.05). At 36 months, there was no difference in adjusted risk of mortality between MI-LAR and OLAR (hazard ratio [HR] 0.88, P = 0.089). In a subgroup analysis of LLAR versus RLAR, there were no differences in lymph node harvest, margin positivity, length of stay, readmission rate, 30-day mortality, or overall survival after adjustment (all P > 0.05).

Conclusions: Minimally invasive LAR for rectal cancer is associated with similar overall survival with the benefit of shorter hospitalization. Although the conversion rate is lower, robotic LAR is not associated with superior oncologic outcomes compared to laparoscopic LAR. Our findings support the ongoing adoption of minimally invasive techniques for rectal adenocarcinoma.

Department of Surgery, Duke University Medical Center, Duke University, Durham, NC.

Reprints: Zhifei Sun, MD, Duke University Medical Center, Box 3443, Durham, NC 27710. E-mail:

Disclosure: The data used in this study are derived from a deidentified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators. The authors declare no conflicts of interest.

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