title: Laparoscopic versus open low anterior resection for rectal cancer: results from the national cancer data base.
abstract: BACKGROUND
  While the use of laparoscopy has increased among patients undergoing colorectal surgery, there is ongoing debate regarding the oncologic equivalence of laparoscopy compared to open low anterior resection (LAR) for rectal cancer.
  
  
  METHODS
  The 2010-2011 NCDB was queried for patients undergoing LAR for rectal cancer. Subjects were grouped by laparoscopic (LLAR) versus open (OLAR) technique. Baseline characteristics were compared. Subjects were propensity matched, and outcomes were compared between groups.
  
  
  RESULTS
  A total of 18,765 patients were identified (34.3% LLAR, 65.7% OLAR). After propensity matching, all baseline variables were highly similar except for carcinoembryonic antigen (CEA) level. Complete resection was more common in patients undergoing LLAR (91.6 vs. 88.9%, p < 0.001), and statistically significant benefits were observed for gross, microscopic, and circumferential (>1 mm) margins (all p < 0.001). There was no difference in median number of lymph nodes obtained (15 vs. 15). Patients undergoing LLAR had shorter lengths of stay (5 vs. 6 days, p < 0.001) without a corresponding increase in 30-day readmission rates (6 vs. 7%, p = 0.02).
  
  
  CONCLUSIONS
  Laparoscopic LAR appears to result in equivalent short-term oncologic outcomes compared to the traditional open approach as measured via surrogate endpoints in the NCDB. While these results support the increasing use of laparoscopy in rectal surgery, further data are necessary to assess long-term outcomes.
authors.affiliation: Department of Surgery, Duke University, Box 3443, Durham, NC, 27710, USA, daniel.nussbaum@duke.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: John
authors.initials: J
authors.lastname: Migaly
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012042:Registries; D016896:Treatment Outcome; D014481:United States
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