Laparoscopic versus open surgery for T4 XXXX : evaluation of margin status.

@entity1 @entity75 @entity3 @entity694 @entity1049
BACKGROUND: Laparoscopic resection has been considered a relative contraindication for T4 @entity1049 due to concern over inadequate margins. The objective of this study was to compare planned laparoscopic and open resections of @entity75 with respect to the positive margin rate. METHODS: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program @entity1 use file to perform a retrospective cohort analysis. The study population consisted of @entity1 that underwent a colorectal resection for a primary T4 lesion during 2011 and 2012. A multiple logistic regression analysis was conducted to determine the adjusted odds ratio (OR) of positive margins based on surgical approach. An inverse probability of treatment weighting (IPTW) analysis was used to account for confounding by indication. A sensitivity analysis including only "as-treated" cases was also performed. RESULTS: The sub-selected population consisted of 455 and 406 @entity1 in the laparoscopic and open group, respectively. In the original cohort, demographic variables were similar. The open group had a higher incidence of comorbidities, @entity3 , and emergency cases. Laparoscopic surgery was found to be no different than open surgery with respect to positive margin status (OR 1.10, p  =  0.54). After IPTW adjustment, surgical approach remained a nonsignificant predictor of positive margins (OR 1.18, p  =  0.31). The "as-treated" analysis also showed that surgical approach had no significant effect on the positive margin rate (OR 1.24, p  =  0.24). CONCLUSIONS: Using this large national surgical database, select @entity1 with @entity75 who underwent planned laparoscopic colorectal resections did not have a significantly higher positive margin rate compared with @entity1 with open operations. Further research is needed to identify the role of laparoscopy in managing T4b lesions before any consensus can be reached regarding its application in locally advanced @entity694 .
