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Objective: To identify patient and hospital related factors associated with laparoscopic abdominoperineal resection (APR) for the treatment of anorectal cancer and compare the in-hospital outcomes between surgical approaches.
Design: Retrospective review of a national administrative database
Setting: Nationwide Inpatient Sample database includes discharge data from 1,051 hospitals located in 45 states, which approximates a 20 percent stratified sample of US community hospitals.
Patients: 2,146 patients from the NIS database during 2008-2010 with rectal cancer undergoing a laparoscopic or open abdominoperineal resection
Interventions: Open versus laparoscopic abdominoperineal resection.
Main Outcome Measures:Intra-operative complications, post-operative complications, length of stay and hospital costs. Patient and Hospital level factors associated with undergoing a laparoscopic abdominoperineal resection: Age, sex, race, primary payer, elixhauser comorbidity, teaching hospital, rural location, hospital region, and hospital volume.
Results: Of the 2,146 patients studied, 22.6% (n=484) underwent a laparoscopic procedure, 74.2% (n=1593) an open procedure, and 3.2% (n=69) were converted to an open procedure. On multivariate analysis, predictors of laparoscopic APR were patients with less significant medical co-morbidities, and procedures performed in high volume centers and urban areas. Compared to patients treated laparoscopically, those treated by open surgery (adjusted odds ratio (AOR) = 1.54 [1.18-2.02]) or those who were converted to open (AOR=1.79 [1.00-3.22]) had higher post operative complications. Patients treated by a laparoscopic approach had significantly shorter hospitalizations (L= 6.9 days; O= 9.0 days; C=8.6 days, p <0.001) and lower adjusted hospital costs (L= $19,697; O= $21,561; C= $22,965, p <0.015).
Conclusions: In this study over 20% of patients with anorectal cancer undergoing APR are treated laparoscopically which was associated with less morbidity, shorter hospitalization, and lower costs of care than open surgery.