BACKGROUND While the ACOSOG and ALaCaRT trials found that laparoscopic resections for rectal cancer failed to demonstrate non-inferiority of pathologic outcomes when compared with open resections, the COLOR II and COREAN studies demonstrated non-inferiority of clinical outcomes, leading to uncertainty regarding the value of minimally invasive (MIS) techniques in rectal cancer surgery. We analyzed differences in pathologic and clinical outcomes between open versus MIS resections for rectal cancer. METHODS We identified patients who underwent resection for stage II or III rectal adenocarcinoma from the National Cancer Database (2010-2015). Surgical approach was categorized as open or MIS (laparoscopic or robotic). Logistic regression and Cox proportional hazard analysis were used to assess differences in outcomes and survival. Analysis was performed in an intention-to-treat fashion. RESULTS A total of 31,190 patients who underwent rectal adenocarcinoma resection were identified, of whom 52.8% underwent open resection and 47.2% underwent MIS resection (31.0% laparoscopic, 16.2% robotic). After adjustment for patient, tumor, and institutional characteristics, MIS approaches were associated with significantly decreased risk of positive circumferential resection margins (OR 0.82, 95% CI 0.72-0.94), increased likelihood of harvesting ≥ 12 lymph nodes (OR 1.12, 95% CI 1.04-1.21), shorter length of stay (OR 0.57, 95% CI 0.53-0.62), and improved overall survival (HR 0.90, 95% CI 0.83-0.98). CONCLUSIONS MIS approaches to rectal cancer resection were associated with improved pathologic and clinical outcomes when compared to the open approach. In this nationwide, facility-based sample of cancer cases in the United States, our data suggest superiority of MIS techniques for rectal cancer treatment.

中文翻译：

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与开放式切除相比，微创直肠癌切除后具有更好的病理和临床效果。

背景技术虽然ACOSOG和ALaCaRT试验发现，与开放式切除术相比，腹腔镜直肠癌切除术未能显示出病理结果的非劣效性，但COLOR II和COREAN研究证明了临床结果的非劣效性，导致对临床价值的不确定性直肠癌手术中的微创（MIS）技术。我们分析了直肠癌开放式与MIS切除之间病理和临床结果的差异。方法我们从国家癌症数据库（2010-2015年）中确定了接受切除的II期或III期直肠腺癌患者。手术方式分为开放式或MIS（腹腔镜或机器人）。Logistic回归和Cox比例风险分析用于评估结果和生存率的差异。以意向治疗方式进行分析。结果共鉴定出31190例行直肠腺癌切除的患者，其中52.8％进行了开放性切除，47.2％进行了MIS切除（腹腔镜检查为31.0％，机器人检查为16.2％）。在根据患者，肿瘤和机构特点进行调整后，MIS方法与显着降低外周切缘阳性的风险相关（OR 0.82，95％CI 0.72-0.94），收获≥12个淋巴结的可能性增加（OR 1.12，95％ CI 1.04-1.21），更短的住院时间（OR 0.57、95％CI 0.53-0.62）和改善的总体生存率（HR 0.90、95％CI 0.83-0.98）。结论与开放式手术相比，MIS直肠癌切除术与改善的病理和临床结果相关。在这个全国范围内