Over the past decade, randomized controlled trials have demonstrated non-inferior oncologic outcomes and decreased morbidity in rectal cancer patients who undergo laparoscopic surgery (LS) when compared to those patients who undergo open surgery (OS); some concern remains regarding inferior specific pathological endpoints among patients undergoing LS. Given the lack of related Canadian data, the objective of this study was to describe the use of LS in rectal cancer surgery at a pan- Canadian and provincial level, and identify factors associated with its use.

Using the Discharge Abstract Database held by the Canadian Institute for Health Information, we identified all adult patients undergoing surgery for rectal cancer from 2004-2014 in all Canadian provinces, excluding Quebec. Exclusion criteria included emergency surgery, pregnancy, lack of a Canadian postal code, or complex multivisceral resection. Baseline demographic characteristics were compared between patients who underwent LS and OS. Provincial and national uptake of LS in rectal cancer was determined by calculating the proportion of LS cases, analysed over time. 

Among the study cohort of 26,441 patients, 22,538 (85.2%) underwent OS and 3,903 (14.76%) underwent LS. Nationally, the uptake of LS increased from 1.4% in 2004 to 34.7% in 2014 (p < 0.0001). The use of LS increased over the study period in all provinces except Newfoundland, with the greatest proportional increase seen in Ontario, British Columbia and Prince Edward Island. In addition to province and year of surgery, other factors associated with the use of LS included female gender (OR 1.33 [95% CI 1.24-1.44]), and younger age (65 and under) (OR 1.15 [95% CI 1.07-1.24]).

The use of LS in rectal cancer in Canada has increased markedly over the past decade, but remains lower than for colon cancer surgery. Significant interprovincial variation exists in the uptake of LS for rectal cancer.

Laparoscopic Rectal Cancer Surgery: A Pan-Canadian Analysis