Minimally Invasive Surgical Approaches Are Safe and Appropriate in N2 Colorectal Cancer

oncological safety of minimally invasive surgery in T4 colorectal cancer; however, such support is lacking in N2 disease. OBJECTIVE: This study aimed to compare oncological and perioperative outcomes of surgical resection for N2 colorectal cancer using an open versus minimally invasive approach. DESIGN: We conducted a retrospective cohort study using the National Surgical Quality Improvement Program's generic and targeted colectomy data sets. SETTINGS: Data about surgery for N2 colorectal cancer were obtained regarding North American hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. PATIENTS: All patients undergoing elective surgical resection for N2 colorectal cancer in participating hospitals between 2014 and 2018 were selected. INTERVENTIONS: Surgical resection of N2 colorectal cancer was performed. MAIN OUTCOME MEASURES: Our primary outcome was nodal yield. Secondary outcomes included perioperative complications and mortality. RESULTS: A total of 1837 patients underwent open and 3907 patients underwent minimally invasive surgery colectomies for N2 colorectal cancer (n = 5744). Median nodal yield was 20 (interquartile range, 15-27) in the open group and 21 (interquartile range, 16-28) in the minimally invasive group (p < 0.0001); however, nodal harvest between the 2 groups was not significantly different on multivariate analysis. Perioperative complications were higher on univariate analysis in the open surgery group, with respect to key outcomes including anastomotic leak and death (p < 0.001). LIMITATIONS: This study is limited by its retrospective design and by the fact that the staging data collected by the National Surgical Quality Improvement Program are pathological rather than clinical; however, prior studies found a 97% concordance between pathological and clinical N2 determination. CONCLUSIONS: Minimally invasive surgery approaches to colorectal cancer with N2 disease result in equivalent nodal harvests compared with open approaches. Our group supports the use of a minimally invasive approach in advanced nodal stage colorectal cancer in the appropriately selected patient. See Video Abstract at http://links.lww.com/DCR/B417.