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Updated: Oct 21, 2025

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Operative Approach Does Not Impact Radial Margin Positivity in Distal Rectal Cancer.

George Q Zhang1, Rebecca Sahyoun1, Miloslawa Stem1

  • 1Department of Surgery, Colorectal Research Unit, Ravitch Colorectal Division, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

World Journal of Surgery
|September 8, 2021
PubMed
Summary
This summary is machine-generated.

Robotic, laparoscopic, and open abdominoperineal resection (APR) for low rectal cancer showed no difference in radial margin positivity. Minimally invasive approaches offer comparable or better outcomes than open surgery.

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Robotic surgery offers potential advantages in dexterity and visualization for low rectal cancer resection.
  • The comparative benefit of different operative approaches for abdominoperineal resection (APR) remains unclear.
  • Radial margin positivity (RMP) is a critical factor in rectal cancer surgery outcomes.

Purpose of the Study:

  • To evaluate the impact of operative approach (robotic, laparoscopic, open) on RMP in patients undergoing APR for low rectal cancer.
  • To compare 30-day postoperative outcomes across different surgical techniques for APR.
  • To identify predictors of RMP in this patient cohort.

Main Methods:

  • Retrospective cohort study using the National Surgical Quality Improvement Program (2016-2019).
  • Included patients undergoing APR for low rectal cancer, excluding emergent cases.
  • Stratified patients by operative approach: robotic APR (R-APR), laparoscopic APR (L-APR), and open APR (O-APR).
  • Primary outcome was RMP; secondary outcomes included 30-day postoperative results. Logistic regression was used for analysis.

Main Results:

  • Out of 1,807 patients, 452 underwent R-APR, 474 L-APR, and 881 O-APR.
  • No significant differences in RMP were observed among R-APR (13.5%), L-APR (10.8%), and O-APR (12.3%) (p=0.44).
  • Operative approach did not predict RMP in adjusted analyses. Predictors of RMP included higher ASA classification, pT3-4 stage, pN2 stage, disseminated cancer, and lack of preoperative radiation.

Conclusions:

  • The operative approach (robotic, laparoscopic, or open) does not influence RMP in APR for low rectal cancer.
  • Robotic APR showed comparable postoperative outcomes to laparoscopic APR and superior outcomes to open APR.
  • Minimally invasive surgery, including robotic and laparoscopic approaches, is a viable option for distal rectal cancer requiring APR.