Outcomes of Minimally Invasive Versus Open Proctectomy for Rectal Cancer: A Propensity-Matched Analysis of Bi-National Colorectal Cancer Audit Data

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dc.contributor.authorBedrikovetski, S.
dc.contributor.authorDudi-Venkata, N.N.
dc.contributor.authorKroon, H.M.
dc.contributor.authorMoore, J.W.
dc.contributor.authorHunter, R.A.
dc.contributor.authorSammour, T.
dc.date.issued2020
dc.description.abstractBackground: Minimally invasive surgery is commonly used in the treatment of rectal cancer, despite the lack of evidence to support oncological equivalence or improved recovery compared with open surgery. Objective: This study aims to analyze prospectively collected data from a large Australasian colorectal cancer database. Design: This is a retrospective cohort study using propensity score matching. Setting: This study was conducted using data supplied by the Bi-National Colorectal Cancer Audit. Patients: A total of 3451 patients who underwent open (n = 1980), laparoscopic (n = 1269), robotic (n = 117), and transanal total mesorectal excision (n = 85) for rectal cancer were included in this study. Main outcome measure: The primary outcome was positive margin rates (circumferential resection margin and/or distal resection margin) in patients treated with curative intent. Results: Propensity score matching yielded 1132 patients in each of the open and minimally invasive surgery groups. Margin positivity rates and lymph node yields did not differ between groups. The open group had a significantly lower total complication rate (27.6% vs 35.8%, p < 0.0001), including a lower rate of postoperative small-bowel obstruction (1.2% vs 2.5%, p = 0.03). The minimally invasive surgery group had significantly lower wound infection rate (2.9% vs 5.0%, p = 0.02) and a shorter length of hospital stay (8 vs 9 days, p < 0.0001). There was no difference in 30-day mortality. Limitations: Results are limited by the quality of registry data entries. Conclusion: In this patient population, minimally invasive proctectomy demonstrated similar margin rates in comparison with open proctectomy, with a reduced length of stay but a higher overall complication rate. See Video Abstract at http://links.lww.com/DCR/B190.
dc.description.statementofresponsibilitySergei Bedrikovetski, Nagendra N. Dudi-Venkata, Hidde M. Kroon, James W. Moore, Ronald A. Hunter, Tarik Sammour
dc.identifier.citationDiseases of the Colon and Rectum, 2020; 63(6):778-787
dc.identifier.doi10.1097/DCR.0000000000001654
dc.identifier.issn0012-3706
dc.identifier.issn0012-3706
dc.identifier.orcidBedrikovetski, S. [0000-0001-9330-625X]
dc.identifier.orcidDudi-Venkata, N.N. [0000-0002-9775-3599]
dc.identifier.orcidKroon, H.M. [0000-0002-8923-7527]
dc.identifier.orcidSammour, T. [0000-0002-4918-8871]
dc.identifier.urihttps://hdl.handle.net/2440/140347
dc.language.isoen
dc.publisherLippincott, Williams & Wilkins
dc.rights© The American Society of Colon & Rectal Surgeons, Inc.
dc.source.urihttps://fascrs.org/
dc.subjectCircumferential resection margin; Laparoscopic proctectomy; Minimally invasive surgery; Rectal cancer; Robotic proctectomy; Transanal total mesorectal excision
dc.subject.meshHumans
dc.subject.meshSurgical Wound Infection
dc.subject.meshRectal Neoplasms
dc.subject.meshIntestinal Obstruction
dc.subject.meshPostoperative Complications
dc.subject.meshLaparoscopy
dc.subject.meshLength of Stay
dc.subject.meshRetrospective Studies
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshMiddle Aged
dc.subject.meshAustralia
dc.subject.meshNew Zealand
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshPropensity Score
dc.subject.meshMinimally Invasive Surgical Procedures
dc.subject.meshRobotic Surgical Procedures
dc.subject.meshMargins of Excision
dc.subject.meshProctectomy
dc.subject.meshData Management
dc.subject.meshOutcome Assessment, Health Care
dc.titleOutcomes of Minimally Invasive Versus Open Proctectomy for Rectal Cancer: A Propensity-Matched Analysis of Bi-National Colorectal Cancer Audit Data
dc.typeJournal article
pubs.publication-statusPublished

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