Association of Surgical Approaches and Outcomes in Total Mesorectal Excision and Margin Status for Rectal Cancer

• Published in: The Journal of surgical research 2024-08, Vol.300, p.494-502
• Main Authors: Mirza, Muhammad Bilal, Gamboa, Adriana C., Irlmeier, Rebecca, Hopkins, Benjamin, Regenbogen, Scott E., Hrebinko, Katherine A., Holder-Murray, Jennifer, Wiseman, Jason T., Ejaz, Aslam, Wise, Paul E., Ye, Fei, Idrees, Kamran, Hawkins, Alexander T., Balch, Glen C., Khan, Aimal
• Format: Article
• Language: English
• Subjects: Laparoscopic surgery; Rectal cancer; Robotic surgery; Surgical margins; Survival outcomes; Total mesorectal excision
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.05.032

Despite being a key metric with a significant correlation with the outcomes of patients with rectal cancer, the optimal surgical approach for total mesorectal excision (TME) has not yet been identified. The aim of this study was to assess the association of the surgical approach on the quality of TME and surgical margins and to characterize the surgical and long-term oncologic outcomes in patients undergoing robotic, laparoscopic, and open TME for rectal cancer. Patients with primary, nonmetastatic rectal adenocarcinoma who underwent either lower anterior resection or abdominoperineal resection via robotic (Rob), laparoscopic (Lap), or open approaches were selected from the US Rectal Cancer Consortium database (2007-2017). Quasi-Poisson regression analysis with backward selection was used to investigate the relationship between the surgical approach and outcomes of interest. Among the 664 patients included in the study, the distribution of surgical approaches was as follows: 351 (52.9%) underwent TME via the open approach, 159 (23.9%) via the robotic approach, and 154 (23.2%) via the laparoscopic approach. There were no significant differences in baseline demographics among the three cohorts. The laparoscopic cohort had fewer patients with low rectal cancer (