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Background: Though complication rates following laparoscopic colon cancer resections have been described, these rates are less certain for laparoscopic rectal cancer surgery. The objective of this study was to identify factors predicting short-term complication rates for patients undergoing laparoscopic (LAPR) and open abdominoperineal resections (OAPR) for rectal cancer, and to identify factors associated with choosing either surgical approach.Methods: Following IRB approval, the 2005-2008 National Surgical Quality Improvement Program’s Participant User File was used to identify patients undergoing LAPR and OAPR for the treatment of rectal cancer. Logistic regression was used to determine which factors influenced selection of an open vs. laparoscopic surgery. Chi-square and multivariable analysis was used to compare the incidence of 30-day postoperative complications between the two surgeries and to identify factors predictive of complications. Results: A total of 1197 OAPR’s and 143 LAPR’s were identified. Compared to OAPR, patients undergoing LAPR were more likely to be female (p=0.02), non-Caucasian (p=0.02) and were less likely to have a body mass index (BMI) of ≥ 30 (p=0.04). LAPR’s were associated with longer operative times (p<0.001), with 57% requiring 4-8 hours. No difference in 30-day postoperative complication rates between LAPR’s and OAPR’s was found with the exception of a higher odds of sepsis with LAPR (OR 3.12; p=0.04). LAPR and OAPR were found to have similar rates of surgical site infections (p=0.13), transfusion requirements (p=0.17), myocardial infarction (p=0.48), and need for re-operation within 30 days (p=0.20). There was no difference in the number of postoperative complications between either group (Table 1). Based on multivariable analysis, the only factor predictive of postoperative complications with LAPR was neoadjuvant radiotherapy (p=0.04). Smoking (p<0.001) and >10% weight loss prior to surgery (p=0.01) predicted complications with OAPR. The odds of undergoing an OAPR was higher with Caucasian race (OR=1.54; p=0.02) and BMI ≥ 25 (OR 1.48; p=0.03). The single factor associated with higher odds of an LAPR was the absence of neoadjuvant radiotherapy (OR=0.37; p=0.04).Conclusions: Short-term complication rates, including surgical site infections, were similar between LAPR and OAPR. Few patients are offered LAPR for cancer, which appears due to surgeon preference rather than consistently identified patient factors.
Number of Postoperative Complications Between Laparoscopic and Open Abdominoperineal Resections

Number of Postoperative Complications	Open APR (n=1197) p=0.18	Laparoscopic APR (n=143) p=0.18
0	789 (65.9%)	103 (72.0%)
1	258 (21.5%)	27 (18.8%)
2	89 (7.4%)	11 (7.6%)
3+	61 (5.1%)	2 (1.4%)