title: Laparoscopic and open abdominoperineal resection for cancer: how patient selection and complications differ by approach.
abstract: BACKGROUND
  Outcomes between laparoscopic (LAPR) and open abdominoperineal resections (OAPR) are poorly described.
  
  
  METHODS
  After IRB approval, 2005-2008 NSQIP data were used to identify patients undergoing LAPR and OAPR for rectal cancer. Logistic regression identified variables influencing the selection of LAPR vs. OAPR as well as the likelihood of postoperative events. Chi-square analysis was used to compare the incidence of 30-day postoperative events.
  
  
  RESULTS
  One thousand one hundred ninety-seven OAPRs and 143 LAPRs were identified. LAPRs were less likely to have a body mass index (BMI) of ≥30 (p = 0.04) and were associated with equivalent mean operative times (p = 0.36). LAPRs and OAPRs were found to have similar rates of surgical site infections (p = 0.13), transfusion requirements (p = 0.17), myocardial infarction (p = 0.48), and need for reoperation within 30 days (p = 0.20). Neoadjuvant radiotherapy did not directly increase complication rates in either group. Few factors predicted choice of LAPR but included BMI <25 (OR, 1.54; p = 0.02).
  
  
  CONCLUSIONS
  Complication rates between LAPR and OAPR were similar despite the greater technical challenge of LAPR. Wound infection rates were equivalent, which may reflect similar rates of perineal wound infections. Few patients are offered LAPR, possibly due to surgeon preferance as opposed to patient factors.
authors: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA. dstewart@hmc.psu.edu
authors: David B
authors: DB
authors: Stewart
authors: Christopher
authors: C
authors: Hollenbeak
authors: Melissa
authors: M
authors: Boltz
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D010502:Perineum / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult