Minimally invasive converted to open versus upfront open surgeries for rectal cancer: a retrospective cohort study

TL;DR

This study compares outcomes of minimally invasive surgeries converted to open versus upfront open surgeries for rectal cancer and finds similar complication rates but shorter hospital stays for the converted approach.

Contribution

The study is the first to directly compare MISC and open surgeries for rectal cancer using a large national database.

Findings

MISC and open surgeries had similar 30-day complication and mortality rates.

MISC was associated with a shorter median length of hospital stay.

Regression analysis confirmed no increased risk for complications with MISC.

Abstract

Minimally invasive surgery (MIS) has significantly better short-term outcomes than open surgery. However, it is unclear whether MIS converted (MISC) to open for rectal cancer carries any benefits compared to open as no prior study has compared these two surgical approaches for rectal cancer. This study compares short-term postoperative outcomes between MISC and upfront open surgery.

This is a retrospective cohort study on elective surgeries for rectal cancer from 2016 and 2022 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into the MISC group and the Open group and balanced using propensity-score matching. 30-day complication, unplanned readmission, and mortality rates and length of stays were compared with Student’s t-test and regression models.

The Open group included 2551 (86.3%) patients, and the MISC group included 406 (13.7%) patients (80.5% laparoscopy, 19.5% robotic). Propensity-score matching yielded 400 patients in each group. On univariate analysis, the groups had comparable overall complications, unplanned readmission, and 30-day mortality rates, but the MISC group had a lower median length of stay (6 days vs. 7 days, p = 0.015). On regression analysis, the MISC was not associated with an increased risk for overall complications (OR = 1.04, 95%CI 0.843–1.280; p = 0.716), unplanned readmission (OR = 1.230, 95%CI 0.939–1.620; p = 0.132), and 30-day mortality (OR = 1.750 95%CI 0.648–4750; p = 0.269). However, MISC was significantly associated with a shorter length of stay (OR = − 0.869, 95%CI (−)1.609 − (−)0.129; p = 0.021).

Patients undergoing planned open proctectomy and those undergoing MISC to open proctectomy exhibit similar 30-day postoperative outcomes. As completed MIS offers advantages over open surgeries, MIS should be attempted as the default surgical approach for rectal cancer patients, even if conversion to open surgery is needed.

The online version contains supplementary material available at 10.1007/s00464-025-11958-0.

Figures