title: The effect of surgical approach on short-term oncologic outcomes in rectal cancer surgery.
abstract: BACKGROUND
  Although evidence to support the use of laparoscopic and robotic approaches for the treatment of rectal cancer is limited, these approaches are being adopted broadly. We sought to investigate national practice patterns and compare short-term oncologic outcomes of different approaches for rectal cancer resections.
  
  
  METHODS
  The 2010 National Cancer Database was queried for operative cases of rectal cancer. Approach was classified as open, laparoscopic, or robotic. Patient, tumor, and hospital characteristics and surgical margin status were evaluated. Propensity score matching was used to compare outcomes across approaches.
  
  
  RESULTS
  We identified 8,712 patients. Laparoscopic and robotic approaches were more common in privately insured and wealthier patients at high-volume centers (P < .001). Open approaches were used for tumors with higher histologic grade and pathologic stage (P < .001). A minimally invasive approach was associated with fewer positive margins and shorter hospital stays. After propensity score matching, the laparoscopic approach was associated with a 2.0% lesser (P = .01) and robotic surgery with a 3.8% lesser (P = .004) incidence of positive margins compared with open surgery.
  
  
  CONCLUSIONS
  An open approach is often used in rectal cancers with higher pathologic stages. Matched patient analysis suggests minimally invasive approaches are associated with improved R0 resections.
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH; Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Midura
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH; Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH; Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Davis
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH; Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH; Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH; Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH. Electronic address: ian.paquette@uc.edu.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Paquette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult