Evolving application of minimally invasive cancer operations at a tertiary cancer center

• Published in: Journal of surgical oncology Vol. 115; no. 4; pp. 365 - 370
• Main Authors: Selby, Luke V., DeMatteo, Ronald P., Tholey, Renee M., Jarnagin, William R., Garcia‐Aguilar, Julio, Strombom, Paul D., Allen, Peter J., Kingham, T. Peter, Weiser, Martin R., Brennan, Murray F., Strong, Vivian E.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15-03-2017
• Subjects: Adenocarcinoma - surgery; Aged; Cancer Care Facilities; Carcinoma, Neuroendocrine - surgery; Digestive System Neoplasms - surgery; Digestive System Surgical Procedures - methods; Digestive System Surgical Procedures - statistics & numerical data; Female; Humans; laparoscopic surgery; Laparoscopy; Laparoscopy - statistics & numerical data; Laparoscopy - trends; Male; Middle Aged; minimally invasive surgery; New York; Patient safety; robotic surgery; Robotic Surgical Procedures - statistics & numerical data; Robotic Surgical Procedures - trends; Robotics; Surgery; surgical oncology; Tertiary Care Centers; minimally invasive surgery; laparoscopic surgery; robotic surgery; surgical oncology
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24526

BACKGROUND
Patients and providers are increasingly interested in the utilization, safety, and efficacy of minimally invasive surgery (MIS). We reviewed 11 years of MIS resections (laparoscopic and robotic) for intra‐abdominal malignancies.
METHODS
Patients who underwent gastrectomy, distal pancreatectomy, hepatic resection, and colorectal resection between 2004 and 2014 were identified. Cases were categorized as open, laparoscopic, and robotic based on the initial operation approach. Diagnostic laparoscopies were excluded.
RESULTS
Of the 10 039 patients who underwent the above procedures, between 2004 and 2014, 2832 (28%) were MIS. In 2004, 12% (100/826) of all resections were performed with MIS approaches, rising to 23% (192/821) of all resections by 2009 and 44% (484/1092) in 2014. The number of open resections has remained largely stable: 726 (88% of all resections) in 2004 and 608 (56% of all resections) in 2014. Initially, laparoscopy experienced incremental adoption. Robotic surgery was implemented in 2009 and is currently the dominant MIS approach, accounting for 76% (368/484) of all MIS resections in 2014. Overall mortality has remained less than 1%.
CONCLUSIONS
While maintaining patient safety, utilization of MIS techniques has increased substantially since 2004, particularly for gastric and colorectal resections. Since 2009 robotic surgery is the predominant MIS approach.