Effects of surgical approach on short- and long-term outcomes in early-stage rectal cancer: a multicenter, propensity score-weighted cohort study.

Autor: Kethman WC; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Bingmer KE; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Ofshteyn A; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Charles R; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Stein SL; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Dietz D; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Steinhagen E; Department of Surgery, Division of Colorectal Surgery, University Hospitals RISES: Research in Surgical Outcomes and Effectiveness, 11100 Euclid Ave, Cleveland, OH, 44106, USA. Emily.Steinhagen@UHhospitals.org.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2022 Aug; Vol. 36 (8), pp. 5833-5839. Date of Electronic Publication: 2022 Feb 04.
DOI: 10.1007/s00464-022-09033-z
Abstrakt: Background: Randomized controlled trials have been unable to demonstrate noninferiority of minimally invasive surgery for rectal cancer. The aim of this study was to assess oncologic resection success, short- and long-term morbidity, and overall survival by operative approach in a homogenous early-stage rectal cancer cohort.
Methods: This is a multicenter, propensity score-weighted cohort study utilizing deidentified data from the National Cancer Database. Individuals who underwent a formal proctectomy for early-stage rectal cancer (T1-2, N0, M0) from 2010 to 2015 were included. The primary outcome was a composite variable indicating successful oncologic resection stratified by operative approach, defined as negative margins with at least 12 lymph nodes evaluated.
Results: Among 3649 proctectomies for rectal adenocarcinoma, 1660 (45%) were approached open, 1461 (40%) laparoscopically, and 528 (15%) robotically. After propensity score weighting, compared to open approach, there were no differences in odds of successful oncologic resection (OR adj  = 1.07, 95% CI 0.9, 1.28 and OR adj  = 1.28, 95% CI 0.97, 1.7). Open approach was associated with longer mean (± SD) length of stay compared to laparoscopic (7.7 ± 0.18 vs. 6.5 ± 0.25 days, p < 0.001) and robotic (7.7 ± 0.18 vs. 6.3 ± 0.35 days, p < 0.001) approaches. In regard to 90-day mortality, compared to open approach, laparoscopic (OR adj  = 0.56, 95% CI 0.36, 0.88) and robotic (OR adj  = 0.45, 95% CI 0.22, 0.94) approaches were associated with a reduced odd of 90-day mortality. This mortality benefit persists in the long-term for laparoscopic approach (p = 0.003).
Conclusion: For individuals with early-stage rectal cancer treated with proctectomy, successful oncologic resection can be achieved irrespective of technical approach. Minimally invasive approaches provide short-term reduction in morbidity. Surgical approach must be tailored to each patient based on surgeon experience and judgement in collaboration with a multi-disciplinary team.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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