H. Alturki1, S. Fang1,2, S. Selvarajah1, N. Nagarajan1, H. Alshaikh1, F. Gani1, C. K. Zogg1, A. Haider1, E. B. Schneider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction: Minimally invasive procedures (laparoscopic and robotic) for the surgical treatment of rectal cancer and have been associated with fewer short-term complications. However, temporal changes in the use of minimally invasive procedures to treat rectal cancer have not been well reported. In this study, changes in the use of minimally invasive techniques to treat rectal cancer were examined across 10 years period.
Methods: The Nationwide Inpatient Sample (NIS) from 2002-2011 was examined to identify adults who were surgically treated for a primary diagnosis of rectal cancer using ICD-9 diagnosis and procedures codes. The data were weighted to produce national population-level estimates. Patient and hospital-level characteristics were described by surgical technique: open vs. minimally invasive which included laparoscopic and robotic techniques. Temporal trends for each type of surgical technique were examined. Factors associated with in-hospital mortality, and changes in mortality across the study period were assessed using multivariable regression, controlling for type of procedure as well as patient and hospital-level factors.
Results: Of 257,994 in-patient who met study criteria, 177,911 (69%) patients underwent open low anterior resection (LAR), 62,889 (24%) open abdominoperineal resection (APR), 9,291 (2%) laparoscopic LAR, 5,227 (3.6%) laparoscopic APR, 2,101 robotic LAR (0.81%) and 575 (0.22%) robotic APR. There was a significant reduction in the proportion of open LAR and APR procedures over the study period, and a concomitant rise in the proportion rectal surgeries performed laparoscopically and robotically (Figure). Minimally invasive procedures were more likely to be performed in male patients, in teaching hospitals, and hospitals located in urban areas (p<.001, all). Over the entire study period, in-hospital mortality was 1.5%; however there was a significant decrease in mortality between 2002 and 2011 (2.0% vs.1.4% respectively, p: <0.05).
Conclusion: There was a significant increase in the use of minimally invasive procedures over the study period. This is may be due to increasing evidence demonstrating reduced morbidity and mortality among patients undergoing minimally invasive vs. open procedures, as well as increasing surgeon experience with minimally invasive techniques and the development of newer instruments for minimally invasive techniques. However, case presentation, as well as variability in surgeon training and experience, may limit the universal adoption of minimally invasive procedures for the treatment of rectal cancer.
