Trends and outcomes in laparoscopic versus open surgery for rectal cancer from 2005 to 2016 using the ACS-NSQIP database, a retrospective cohort study

Background: There is controversy regarding the use of laparoscopy for rectal cancer, especially after the ACOSOG Z6051 Randomized Clinical Trial determined that laparoscopy failed to meet non-inferiority compared with open surgery. With these new recommendations, the current practices for the treatment of rectal cancer across the country are unknown. Methods: Using the ACS-NSQIP database from 2005 to 2016, resections for rectal cancer were studied. The proportion of laparoscopic versus open surgeries performed was determined by year, and 16 30-day outcomes were studied in each group. Multiple logistic regression was utilized to determine the association between laparoscopic and open technique as well as odds of outcome over time. Results: A total of 31,795 resections were performed, 12,371 (38.9%) laparoscopically. Laparoscopy increased yearly from 9.8% in 2005 to 52.8% in 2016. All 30-day outcomes tended to favor laparoscopy with the exception of operating room time. Conclusions: These data suggest that laparoscopic surgery has been widely adopted for treating patients with rectal cancer, and the trend continues despite the ACOSOG Z6051 recommendations suggesting that laparoscopic resection may not be best technique for resection. Stronger recommendations are needed to change current trends if laparoscopic surgery is not the appropriate treatment method for rectal cancer.