EP822 - Demographic Variability in Operative Approach to Proctectomy for Rectal Cancer: Implications for Surgical Outcomes

Monday, May 12, 2025

1:25 PM – 1:30 PM PT

ePoster Presenter(s)

Ama J. Winland, MD

General Surgery Resident
Walter Reed National Military Medical Center
Walter Reed National Military Medical Center
Chevy Chase, MD, United States

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

Author(s)

RS

Reena S. Suresh, MBCHB

Research Fellow
Johns Hopkins Medical Institutions
Johns Hopkins School of Medicine
Baltimore, Maryland, United States

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This individual has no financial relationships with ineligible companies.
MS

Miloslawa Stem, MS

Research Associate
Johns Hopkins School of Medicine
Balitmore, Maryland, United States

Disclosure information not submitted.
JM

Jay Maturi, BS

Medical Student
Johns Hopkins School of Medicine
Baltimore, Maryland, United States

Disclosure information not submitted.
Alodia Gabre-Kidan, MD, MPH

Assistant Professor of Surgery
Johns Hopkins School of Medicine
Johns Hopkins School of Medicine
Towson, MD, United States

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This individual has no financial relationships with ineligible companies.
Susan Gearhart, MD

Associate Professor of Surgery
Johns Hopkins Medicine
Baltinore, Maryland, United States

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This individual has no financial relationships with ineligible companies.
AG

Ada E. Graham, MD

Assistant Professor of Surgery
Johns Hopkins University
Bethesda, Maryland, United States

Disclosure information not submitted.

Senior Author(s)

Vincent Obias, MD (he/him/his)

Professor of Surgery (PAR)
Johns Hopkins University
Johns Hopkins Medicine
Baltimore, Maryland, United States

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

All of the relevant financial relationships listed below have been mitigated.

Ama J. Winland, MD: This individual has no financial relationships with ineligible companies.

Reena S. Suresh, MBCHB: This individual has no financial relationships with ineligible companies.

Alodia Gabre-Kidan, MD, MPH: This individual has no financial relationships with ineligible companies.

Susan Gearhart, MD: This individual has no financial relationships with ineligible companies.

Vincent Obias, MD: This individual has no relevant relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Rectal cancer surgery is evolving rapidly, with an increasing number of cases transitioning to minimally invasive platforms. There have been conflicting data to support whether minimally invasive surgery (MIS), specifically robotics, translates to better outcomes. Despite widespread adoption of MIS techniques, a significant number of patients continue to undergo open procedures. The aim of this study was to determine temporal trends and identify patient demographic and clinical factors associated with specific surgical approaches.

Methods/Interventions: This retrospective study utilized the National Cancer Database to identify adult rectal adenocarcinoma patients (stage I-III) undergoing surgery from 2010 to 2021. Patients were stratified by surgical approach (robotic, lap, open). Temporal trends in surgical approach were examined. Multivariable logistic regression analysis identified patient factors associated with each surgical approach. Propensity score matching which included stage was used to compare R0 resection, the primary outcome, between groups for the more recent years (2018-2021).

Results/Outcomes: Among the 102,194 rectal cancer cases included, 40.4% underwent an open approach, 32.7% were laparoscopic, and 26.9% were robotic. The number of robotic surgeries surpassed open surgeries in 2017, with robotic cases continuing to increase while open cases declined (Figure). By 2021, robotic surgeries accounted for 51.4% of rectal cancer procedures, compared to just 21.8% for open surgeries. Among patients treated between 2018-2021, factors associated with robotic approach included private insurance (odds ratio [OR] 1.52, 95% confidence interval [CI]: 1.31-1.75), neoadjuvant chemoradiation (OR 1.60, CI 1.51-1.70), and surgery performed at an Integrated Network Cancer Program (OR 1.43, CI 1.34-1.53). Factors associated with open approach included lower household income (OR 1.67, CI 1.55-1.81), lack of insurance (OR 1.92, CI 1.66-2.22), non-segmental resections (OR: 0.90, CI 0.80-1.01), and surgery performed at a Community Cancer Program (OR: 1.37, CI 1.27-1.47) or Academic/Research Program (OR 1.34, CI 1.25-1.44). Factors associated with laparoscopic approach included lack of neoadjuvant chemoradiation (OR 1.53, CI 1.44-1.63). In the matched analysis, R0 resection rates were significantly higher in the robotic group, when compared to both open (94.2% vs. 91.2%, p < 0.001), and laparoscopic groups (94.8% vs. 93.60%, p< 0.001). Robotic cases also exhibited lower rates of conversion to open procedure compared to the laparoscopic group (5.0% vs.11.4%, p< 0.001).

Conclusion/Discussion: It is essential to investigate the factors driving surgical approach choices to reduce disparities and expand access to robotic surgery for all patients. This is especially important as robotic rectal cancer cases have now been shown to have better outcomes not only for recovery but oncologically.