Abstract
Pelvic exenteration (PE) entails an en bloc resection of locally advanced primary or recurrent rectal cancer. This study aimed to assess the short-term and survival outcomes of minimally invasive (MI)- and open PE. A retrospective cohort analysis of patients with stage III rectal adenocarcinoma treated with PE from the National Cancer Database (2010-2019) was conducted. Open and MI-PE were matched for baseline and treatment characteristics using 2:1 propensity score matching. Primary outcomes were 30- and 90-day mortality; secondary outcomes included 30-day readmission, hospital stay, surgical margins, lymph node yield, and overall survival (OS). PE was performed in 1010 (1.9%) of 52,242 patients; 705 (69.8%) were open and 304 were (30.2%) MI procedures. After matching, 169 patients in the MI-PE group were matched to 338 patients in the open PE group. The matched cohort included 507 patients (54.2% female). Hospital stay was shorter after MI compared to open PE (median: 6 vs. 8 days, p < 0.001). MI and open PE had similar odds of 30- (OR: 0.33, p = 0.306) and 90-day mortality (OR: 0.29, p = 0.113), and comparable rates of positive surgical margins (12.7% vs. 15%, p = 0.586) and suboptimal lymph node yield (19% vs. 26%, p = 0.096). MI-PE had a similar OS to open surgery (82.5 vs. 77.5 months, p = 0.281). Robotic-assisted PE was associated with significantly lower odds of conversion to open surgery (OR: 0.15, p = 0.003) and shorter hospital stay (median: 5 vs. 7 days, p = 0.026) than laparoscopic PE. MI-PE provided similar pathologic and survival outcomes to open PE with comparable short-term mortality rates and significantly shorter hospital stays.