The Impact of Conversion to Laparotomy in Rectal Cancer : A National Cancer Database Analysis of 57 574 Patients

The American Surgeon
Salvatore A ParascandolaVincent Obias

Abstract

Data regarding the effect of conversion from minimally invasive surgery (MIS) to laparotomy in rectal cancer is limited. This study examines the impact of conversion from laparoscopic or robotic-assisted techniques to open resection on oncologic outcomes in a large population database. The National Cancer Database from 2010 to 2016 was reviewed for all cases of invasive adenocarcinoma of the rectum or rectosigmoid junction managed surgically. Patients were divided into 3 cohorts by approach: laparoscopic/robotic (MIS), converted proctectomy (CP), and open proctectomy (OP). Kaplan-Meier estimation was used for unadjusted survival analysis, followed by adjusted multivariable Cox-Proportional Hazards regression. Secondary outcomes were analyzed by multivariable logistic regression. The inclusion criteria identified 57 574 patients cases of adenocarcinoma of the rectum managed surgically. Of these patients, 23 579 (41.0%) underwent MIS, 3591 (6.2%) CP, and 30 404 (52.8%) OP. Five-year overall survival was greater in the MIS (70.4%) versus CP and OP (64.4% and 61.4%). No differences were detected for positive margins, 30-day, or 90-day mortality between CP and OP. MIS and CP approaches were significantly associated with increased od...Continue Reading

References

May 14, 2004·The New England Journal of Medicine·UNKNOWN Clinical Outcomes of Surgical Therapy Study GroupDavid Ota
Jan 20, 2005·Diseases of the Colon and Rectum·Annibale D'AnnibaleDaniela Guidolin
Jul 5, 2005·The Lancet Oncology·Ruben VeldkampUNKNOWN COlon cancer Laparoscopic or Open Resection Study Group (COLOR)
Nov 28, 2012·The Surgical Clinics of North America·Anjali S Kumar, Sang W Lee
Feb 6, 2014·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Chang Woo KimSeung Hyuk Baik
Apr 2, 2015·The New England Journal of Medicine·H Jaap BonjerUNKNOWN COLOR II Study Group
Oct 13, 2016·World Journal of Gastroenterology : WJG·Marco E AllaixMario Morino

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