The effect of surgical approach on short-term oncologic outcomes in rectal cancer surgery
| Autor: | Bradley R. Davis, Emily F. Midura, Dennis J. Hanseman, Shimul A. Shah, Richard S. Hoehn, Daniel E. Abbott, Ian M. Paquette |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Surgical margin medicine.medical_specialty Adolescent Databases Factual Colorectal cancer Young Adult Robotic Surgical Procedures Humans Medicine Robotic surgery Practice Patterns Physicians' Propensity Score Aged Retrospective Studies Aged 80 and over Surgical approach Rectal Neoplasms business.industry Incidence (epidemiology) Rectum Cancer Length of Stay Middle Aged medicine.disease United States Surgery Treatment Outcome Propensity score matching Rectal cancer surgery Female Laparoscopy business |
| Zdroj: | Surgery. 158:453-459 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2015.02.020 |
| Popis: | Although evidence to support the use of laparoscopic and robotic approaches for the treatment of rectal cancer is limited, these approaches are being adopted broadly. We sought to investigate national practice patterns and compare short-term oncologic outcomes of different approaches for rectal cancer resections.The 2010 National Cancer Database was queried for operative cases of rectal cancer. Approach was classified as open, laparoscopic, or robotic. Patient, tumor, and hospital characteristics and surgical margin status were evaluated. Propensity score matching was used to compare outcomes across approaches.We identified 8,712 patients. Laparoscopic and robotic approaches were more common in privately insured and wealthier patients at high-volume centers (P.001). Open approaches were used for tumors with higher histologic grade and pathologic stage (P.001). A minimally invasive approach was associated with fewer positive margins and shorter hospital stays. After propensity score matching, the laparoscopic approach was associated with a 2.0% lesser (P = .01) and robotic surgery with a 3.8% lesser (P = .004) incidence of positive margins compared with open surgery.An open approach is often used in rectal cancers with higher pathologic stages. Matched patient analysis suggests minimally invasive approaches are associated with improved R0 resections. |
| Databáze: | OpenAIRE |
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