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Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer.

Publication ,  Journal Article
Sun, Z; Kim, J; Adam, MA; Nussbaum, DP; Speicher, PJ; Mantyh, CR; Migaly, J
Published in: Ann Surg
June 2016

OBJECTIVE: To examine survival of patients who underwent minimally invasive versus open low anterior resection (LAR) for rectal cancer. BACKGROUND: Utilization of laparoscopic and robotic LAR for rectal cancer has steadily increased. Short-term outcomes between these techniques and open surgery have shown equivalent results; however, survival outcomes are unknown. METHODS: Adults from the National Cancer Data Base undergoing LAR for rectal adenocarcinoma were identified. Patients were stratified by intent-to-treat into open (OLAR) or minimally invasive LAR (MI-LAR). Multivariable modeling was used to compare short-term outcomes and survival between MI-LAR and OLAR and between laparoscopic (LLAR) and robotic LAR (RLAR). RESULTS: Among 14,033 patients included, 57.8% underwent OLAR and 42.2% MI-LAR. After adjustment, MI-LAR was associated with shorter length of stay (P < 0.001), but similar rates of positive margins, 30-day readmission, 30-day mortality, and use of adjuvant therapies (all P > 0.05). At 36 months, there was no difference in adjusted risk of mortality between MI-LAR and OLAR (hazard ratio [HR] 0.88, P = 0.089). In a subgroup analysis of LLAR versus RLAR, there were no differences in lymph node harvest, margin positivity, length of stay, readmission rate, 30-day mortality, or overall survival after adjustment (all P > 0.05). CONCLUSIONS: Minimally invasive LAR for rectal cancer is associated with similar overall survival with the benefit of shorter hospitalization. Although the conversion rate is lower, robotic LAR is not associated with superior oncologic outcomes compared to laparoscopic LAR. Our findings support the ongoing adoption of minimally invasive techniques for rectal adenocarcinoma.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

June 2016

Volume

263

Issue

6

Start / End Page

1152 / 1158

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Rectal Neoplasms
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Laparoscopy
 

Citation

APA
Chicago
ICMJE
MLA
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Sun, Z., Kim, J., Adam, M. A., Nussbaum, D. P., Speicher, P. J., Mantyh, C. R., & Migaly, J. (2016). Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer. Ann Surg, 263(6), 1152–1158. https://doi.org/10.1097/SLA.0000000000001388
Sun, Zhifei, Jina Kim, Mohamed A. Adam, Daniel P. Nussbaum, Paul J. Speicher, Christopher R. Mantyh, and John Migaly. “Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer.Ann Surg 263, no. 6 (June 2016): 1152–58. https://doi.org/10.1097/SLA.0000000000001388.
Sun Z, Kim J, Adam MA, Nussbaum DP, Speicher PJ, Mantyh CR, et al. Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer. Ann Surg. 2016 Jun;263(6):1152–8.
Sun, Zhifei, et al. “Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer.Ann Surg, vol. 263, no. 6, June 2016, pp. 1152–58. Pubmed, doi:10.1097/SLA.0000000000001388.
Sun Z, Kim J, Adam MA, Nussbaum DP, Speicher PJ, Mantyh CR, Migaly J. Minimally Invasive Versus Open Low Anterior Resection: Equivalent Survival in a National Analysis of 14,033 Patients With Rectal Cancer. Ann Surg. 2016 Jun;263(6):1152–1158.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

June 2016

Volume

263

Issue

6

Start / End Page

1152 / 1158

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Rectal Neoplasms
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Laparoscopy