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Defining the Role of Minimally Invasive Proctectomy for Locally Advanced Rectal Adenocarcinoma
Sarath Sujatha-Bhaskar1, Mehraneh D Jafari, John V Gahagan
1Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA.
Annals of Surgery
|June 27, 2017
Summary
Laparoscopic proctectomy (LP) offers improved oncological outcomes, including better margin-negative rates and overall survival, compared to open proctectomy (OP) for rectal cancer. Further research is needed to confirm these benefits for robotic proctectomy (RP).
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Rectal adenocarcinoma treatment is shifting towards minimally invasive techniques like laparoscopic proctectomy (LP) and robotic proctectomy (RP).
- The oncological implications of these minimally invasive approaches for rectal cancer require thorough investigation.
Purpose of the Study:
- To compare pathological outcomes and overall survival (OS) between open proctectomy (OP), LP, and RP.
- To evaluate the oncological efficacy of minimally invasive proctectomy techniques.
Main Methods:
- Retrospective analysis of the National Cancer Database (2010-2014) for patients with nonmetastatic locally advanced rectal adenocarcinoma.
- Stratification by surgical approach (OP, LP, RP) following neoadjuvant chemoradiation, resection, and adjuvant therapy.
- Multivariate analysis for pathological outcomes and Cox proportional-hazard/Kaplan-Meier analyses for OS.
Main Results:
- Laparoscopic proctectomy (LP) demonstrated superior circumferential margin negativity rates compared to open proctectomy (OP) (OR 1.34, P=0.036).
- LP was associated with a lower hazard ratio for death compared to OP (HR 0.81, P=0.037).
- Five-year overall survival was 81% for LP, 78% for RP, and 76% for OP (P=0.0198).
Conclusions:
- Laparoscopic proctectomy (LP), when performed by experienced surgeons on selected patients, may offer oncological advantages for rectal cancer.
- Further prospective randomized trials are recommended to definitively compare open and minimally invasive proctectomy techniques regarding pathological outcomes and long-term survival.
