Minimally invasive surgery and sphincter preservation in rectal cancer.

Overview

BACKGROUND: National adoption of sphincter-preserving surgery (SPS) and minimally invasive surgery (MIS) has not been well documented. We examined national trends in use of SPS and MIS. MATERIALS AND METHODS: The National Inpatient Sample was used to evaluate open, laparoscopic, and robotic low anterior resection (LAR) or abdominoperineal resection (APR) for patients undergoing rectal cancer surgery from 2009 to 2011. Trends in SPS and MIS were stratified by hospital volume. Propensity score matching was used. RESULTS: A total of 24,999 (62.0%) patients underwent LAR, and 15,288 (38.0%) underwent APR from 2009 to 2011. A total of 22,310 (89.2%) LARs were open and 2689 (10.8%) MIS. A total of 11,600 (75.9%) APRs were open and 3688 (24.1%) MIS. Most procedures were at high-volume centers. In propensity-matched analysis, length of stay for LAR was longer in open surgery (6 versus 5 d; P = 0.01); in APR, MIS patients were less likely to have wound, infectious, urinary, and gastrointestinal complications, and length of stay was shorter (6 versus 8 d; P < 0.01). CONCLUSIONS: SPS and MIS rates have increased nationally, especially in high-volume centers. In addition, the perioperative benefits seen in randomized clinical trials are maintained in a national database. Further studies should focus on understanding differences in survival and oncologic outcomes with MIS techniques.