eP671 - Evaluation of Recent Outcomes for Rectal Cancer Proctectomies Utilizing the ACS-NSQIP Database

Purpose/Background: The aim of this study was to evaluate proctectomy outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2018-2021. Surgical approach–robotic, laparoscopic and open–and leak rate–overall and for low rectal tumors–were evaluated. Secondary outcomes for ileus and stoma formation rate were analyzed.Methods/Interventions: The ACS-NSQIP database was queried to identify all reported proctectomies during the study period. Surgical approach, tumor location, and rectal cancer stage was analyzed along with ileus, leak rate, and stoma formation. A Pearson chi-square test was used to analyze the distribution of trends.Results/Outcomes: 18,043 proctectomies were included. There was a relative difference in surgical approach by tumor stage with 37.1% laparoscopic in stage I tumors vs. 17.9% in stage IV tumors (p < 0.003; Table 1A). There was a statistically significant difference in leak rate by tumor stage with a rate of 3.7% in stage IV tumors, 2.8% in stage III, 3.2% in stage II and 1.6% in stage I tumors (p < 0.002). The rate of stoma formation was highest in open cases (36.2%), followed by laparoscopic (30.1%) and lowest in robotic cases (18.8%) (p < 0.002). The overall rate of ileus (n=3102) in a prepped colon was 60.3% while 58.5% in an unprepped colon. For low rectal tumors (n=4089), the rate of ileus (n=772) was 74.4% in a prepped 76.3% in an unprepped colon. Low rectal tumors were approached with a minimally invasive approach more often when they were lower stage–robotic (23.8% stage I and 25.5% stage II) and laparoscopic (32.5% stage I and 26.9% stage II)--with more open surgery in stage IV (47.7%) low rectal tumors (p < 0.003)(Table 1B) . There was no significant difference in leak rate for low rectal cancers by stage with 4% in stage IV low rectal tumors, 1.7% in Stage III, 1.9% in stage II, and 1.1% in stage I low rectal tumors (p=0.211). The rate of stoma formation was not statically significant between surgical approaches–robotic (25.6%), laparoscopic (26.8%) and open (31.8%) for low rectal tumors (p=0.06).Conclusion/

Discussion: There is a higher rate of leak in more advanced stage tumors with a decreased laparoscopic approach and increased use of open surgery in stage IV disease. Concurrently, there is an increased use of minimally invasive approaches in lower stage tumors. Advanced rectal cancer stage could influence surgical approach, stoma formation and leak rate more than tumor location."Table 1A. Difference in tumor surgical approach by pre-operative stage for all proctectomies. 1B. Difference in tumor surgical approach by pre-operative stage for low rectal tumor

Table 2A. Leak rate by disease stage in all proctectomies 2B. Leak rate by disease stage in proctectomies for low rectal tumors
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