Defining the Role of Minimally Invasive Proctectomy for Locally Advanced Rectal Adenocarcinoma

Autor: Sarath Sujatha-Bhaskar, Christina Y. Koh, John V. Gahagan, Joseph C. Carmichael, Alessio Pigazzi, Michael J. Stamos, Steven Mills, Mehraneh D. Jafari, Colette S. Inaba
Rok vydání: 2017
Předmět:
robotic
Male
Oncology
Multivariate analysis
Colorectal cancer
Kaplan-Meier Estimate
Medical and Health Sciences
laparoscopic
0302 clinical medicine
Rectal Adenocarcinoma
Medicine
Adjuvant
Digestive System Surgical Procedures
Cancer
total mesorectal excision
Hazard ratio
Chemoradiotherapy
Robotics
Middle Aged
Neoadjuvant Therapy
Intention to Treat Analysis
Treatment Outcome
Chemotherapy
Adjuvant
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Patient Safety
rectal adenocarcinoma
medicine.medical_specialty
Adenocarcinoma
03 medical and health sciences
Rare Diseases
Clinical Research
Internal medicine
Adjuvant therapy
Chemotherapy
Humans
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Rectal Neoplasms
business.industry
Rectum
Chemoradiotherapy
Adjuvant
Odds ratio
medicine.disease
Confidence interval
Surgery
proctectomy
Laparoscopy
Digestive Diseases
business
Zdroj: Annals of surgery, vol 266, iss 4
ISSN: 0003-4932
DOI: 10.1097/sla.0000000000002357
Popis: Author(s): Sujatha-Bhaskar, Sarath; Jafari, Mehraneh D; Gahagan, John V; Inaba, Colette S; Koh, Christina Y; Mills, Steven D; Carmichael, Joseph C; Stamos, Michael J; Pigazzi, Alessio | Abstract: ObjectiveNational examination of open proctectomy (OP), laparoscopic proctectomy (LP), and robotic proctectomy (RP) in pathological outcomes and overall survival (OS).BackgroundSurgical management for rectal adenocarcinoma is evolving towards utilization of LP and RP. However, the oncological impacts of a minimally invasive approach to rectal cancer have yet to be defined.MethodsRetrospective review of the National Cancer Database identified patients with nonmetastatic locally advanced rectal adenocarcinoma from 2010 to 2014, who underwent neoadjuvant chemoradiation, surgical resection, and adjuvant therapy. Cases were stratified by surgical approach. Multivariate analysis was used to compare pathological outcomes. Cox proportional-hazard modeling and Kaplan-Meier analyses were used to estimate long-term OS.ResultsOf 6313 cases identified, 53.8% underwent OP, 31.8% underwent LP, and 14.3% underwent RP. Higher-volume academic/research and comprehensive community centers combined to perform 80% of laparoscopic cases and 83% of robotic cases. In an intent-to-treat model, multivariate analysis demonstrated superior circumferential margin negativity rates with LP compared with OP (odds ratio 1.34, 95% confidence interval 1.02-1.77, P = 0.036). Cox proportional-hazard modeling demonstrated a lower death hazard ratio for LP compared with OP (hazard ratio 0.81, 95% confidence interval 0.67-0.99, P = 0.037). Kaplan-Meier analysis demonstrated a 5-year OS of 81% in LP compared with 78% in RP and 76% in OP (P = 0.0198).ConclusionIn the hands of experienced colorectal specialists treating selected patients, LP may be a valuable operative technique that is associated with oncological benefits. Further exploration of pathological outcomes and long-term survival by means of prospective randomized trials may offer more definitive conclusions regarding comparisons of open and minimally invasive technique.
Databáze: OpenAIRE
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