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Minimally Invasive Proctectomy Is Associated With Reduced Margin Positivity And Improved Survival In Patients With Locally Advanced Rectal Cancer
Sarath Sujatha-Bhaskar, Mehraneh D Jafari, John V. Gahagan, Steven Mills, Joseph C Carmichael, Michael J Stamos, Alessio Pigazzi
University of California, Irvine School of Medicine, Orange, CA

OBJECTIVE(S): Surgical management for rectal adenocarcinoma is evolving towards utilization of minimally invasive (MIS) techniques. The oncological impacts of an MIS approach to rectal cancer have yet to be defined. We aim to examine the oncological outcomes of minimally invasive proctectomy.
METHODS: Retrospective review of the National Cancer Database identified patients with non-metastatic rectal adenocarcinoma from 2010-2014 who underwent neoadjuvant chemoradiation, surgical resection, and adjuvant therapy. Cases were stratified by surgical approach (open, laparoscopic or robotic). Multivariate analysis was used to compare perioperative outcomes. Cox proportional hazard modeling estimated long-term all-cause survival.
RESULTS: Of 5,830 cases of rectal adenocarcinoma, 3,311 (56%) underwent open proctectomy (OP), 1,695 (29%) underwent laparoscopic proctectomy (LP), and 824 (14%) underwent robotic proctectomy (RP). Compared with open resection, RP (OR 1.99, 95% CI 1.35-2.93, p <0.05) and LP (1.60, 1.22-2.10, p < 0.05) offered higher rates of overall negative margins. RP (1.81, 1.23-2.66, p < 0.05) and LP (1.79, 1.34-2.40, p < 0.05) yielded superior negative circumferential margin rates compared to OP. RP and LP were equivalent with respect to margin positivity. LP (0.80, 0.65-0.98, p < 0.05) revealed lower 5-year death hazard rates than OP. RP and LP demonstrated similar death rates.
CONCLUSIONS: While open proctectomy remains the predominant technique for surgical resection of rectal adenocarcinoma, robotic and laparoscopic approaches are associated with reduced margin positivity and improved overall survival.

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