Real-World Impact of Laparoscopic Surgery for Rectal Cancer: A Population-Based Analysis

Background: Randomized trials have demonstrated equivalent oncologic outcomes and decreased morbidity in patients with rectal cancer who undergo laparoscopic surgery (LapSx) compared with open surgery (OpenSx). The objective of the present study was to compare short-term outcomes after LapSx and OpenSx in a real-world setting. Methods: A national discharge abstract database was used to identify all patients who underwent rectal cancer resection in Canada (excluding Quebec) from April 2004 through March 2015. Short-term outcomes examined included same-admission mortality and length of stay (los). Results: Of 28,455 patients, 82.4% underwent OpenSx, and 17.6%, LapSx. The use of LapSx increased to 34% in 2014 from 5.9% in 2004 (p < 0.0001). Same-admission mortality was lower among patients undergoing LapSx than among those undergoing OpenSx (1.08% and 1.95% respectively, p < 0.0001). On multivariable analysis, the odds of same-admission mortality with LapSx was 36% lower than that with OpenSx (odds ratio: 0.64; p = 0.003). Median los was shorter after LapSx than after OpenSx (5 days and 8 days respectively, p = 0.0001). The strong association of LapSx with shorter los was maintained on multivariable analysis controlling for patient, surgeon, and hospital factors. Conclusions: For patients with rectal cancer, shorter los and decreased same-admission mortality are associated with the use of LapSx compared with OpenSx.