eP358 - Comparing Outcomes of Open vs Minimally Invasive Total Mesorectal Excision After Total Neoadjuvant Therapy in Rectal Cancer - NCDB Analysis

Sunday, June 2, 2024

11:03 AM – 11:08 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Shravani Sripathi, MD

Resident
Central Michigan University Medical Education Partners - - Saginaw, MI
Central Michigan University Medical Education Partners
Saginaw, MI, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

FP

Felipe Andres Pacheco, MD

Surgery Resident
Central Michigan University
Saginaw, Michigan, United States

Disclosure information not submitted.
Danielle L. Humphries, MD

Resident Physician
Central Michigan University
Central Michigan University College of Medicine
Saginaw, MI, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
ANASTASIYA SHCHATSKO, MD

resident, PGY5
Central Michigan University
Central Michigan University
Saginaw, MI, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SP

Sundarachalam Pindicura, MD

Resident
CMU Medical Education Partners
Saginaw, Michigan, United States

Disclosure information not submitted.
MK

Mohamed K. Kamel, MD

Surgery
University of Rochester Medical Center
Rochester, New York, United States

Disclosure information not submitted.
wS

wael Solh, MD FASCRS

Section chief general surgery
CMU college of medicine
Saginaw, Michigan, United States

Disclosure information not submitted.

Senior Author(s)

MO

Marar Omar, MD

Colon and Rectal Surgeon
Central Michigan University Health
Saginaw, Michigan, United States

Disclosure information not submitted.

Purpose/Background: Total Neoadjuvant Therapy (TNT) is a novel approach to rectal cancer management. In TNT, both systemic chemotherapy and radiation are administered before surgery. It has been shown to improve pathological complete response, disease-free survival, local recurrence, and treatment compliance compared to standard therapy. There are no large retrospective database studies performed comparing the outcomes of open vs minimally invasive surgery (MIS) approaches after TNT in rectal cancers.Methods/Interventions: National Cancer Database was analyzed from 2010-2020. Inclusion criteria – Rectal cancer stage 2 and 3, who received chemotherapy and radiation therapy prior to surgery. Only patients who received two or more chemotherapeutic agents were included in the study. Exclusion criteria - Patients with stage 1 or 4 rectal cancer, who had primary resection without neoadjuvant therapy, and patients who had MIS converted to open. Univariate analysis and multivariate logistic regression analysis were performed. The primary outcome is lymph node retrieval. The secondary outcome is 90-day mortality.Results/Outcomes: A total of 5962 patients with the inclusion criteria for the TNT group were identified. 3111 (52.2%) underwent a minimally invasive surgery (MIS) approach. 2851 (47.8%) had open surgery. The number of patients who had inadequate lymph node retrieval ( < 12 nodes) was 842 (27.1%) in the MIS group and 947 (33.2%) in the open group with OR 0.7999 (CI 0.712 – 0.897 p < 0.001). 90-day mortality in the open group was 2.2 % (62) compared to 0.8% (24) in the MIS group with OR 2.464 (CI 1.509 - 4.025 p < 0.001).Conclusion/

Discussion: Rectal cancer management is constantly evolving. In patients undergoing Total Neoadjuvant Therapy for rectal cancer, a Minimally invasive approach is associated with a higher chance of an adequate lymph node harvest and a lower 90-day mortality. This may be explained by the fact that a minimally invasive approach provides better exposure with a more precise dissection, particularly in the deep pelvis. However, it may also be due to a selection bias, as open cases are more likely to be advanced tumors with tumor replacement of the lymph nodes, which would lead to a lower harvest if it is responsive to treatment. Further prospective studies are needed to fully understand the implications of TNT on the operative approach.