SPONGE assisted Laparoscopic or robotic surgery of sigmoid colon and rectum fails to reduce hospital stay

Laparoscopic/robotic surgery for sigmoid colon and rectum with sponge assistance does not shorten hospital stays or lower perioperative morbidity or death, says an article published in British Journal of Surgery.

An alternative to the Trendelenburg position in minimally invasive surgery of the sigmoid colon and rectum is the retractor sponge. This randomized clinical study (RCT), carried out by Milad Fahim and colleagues, examined the postoperative duration of hospitalization and perioperative outcomes among patients with sigmoid or rectal cancer who underwent sponge-assisted vs Trendelenburg position surgery.

The SPONGE study is a single-center RCT that adheres to the Trials within Cohorts (TwiCs) design and is nested inside the Dutch countrywide prospective observational cohort of patients with colon cancer. Block randomization was used to randomly assign sigmoid or rectal cancer patients undergoing elective laparoscopic or robotic surgery to either sponge-assisted or Trendelenburg surgery on a 1:1 basis. The Mann-Whitney U test was used to compare the primary outcome, which was the length of postoperative hospital stay. In intention-to-treat and per-protocol analyses, secondary outcomes included the percentage of complications, readmissions, or death compared to the χ2 test. 

The key findings of this study were:

1. 81 patients received Trendelenburg surgery and 82 received sponge-assisted surgery between November 2015 and June 2021.

2. 150 patients were left after post-randomization exclusion for analysis (75 patients per arm).

3. There was no statistically significant difference in mortality (0 percent against 1%, P = 1.00), readmission rate (8 percent compared 15 percent), 30-day postoperative complications (30 percent versus 31 percent), or the median length of hospital stay (5 days versus 4 days, respectively).

4. The results of the per-protocol analysis were comparable.

5. There were no unfavorable device occurrences.

Reference:

Fahim, M., Couwenberg, A., Verweij, M. E., Dijksman, L. M., Verkooijen, H. M., & Smits, A. B. (2022). SPONGE-assisted versus Trendelenburg position surgery in laparoscopic sigmoid and rectal cancer surgery (SPONGE trial): randomized clinical trial. In British Journal of Surgery (Vol. 109, Issue 11, pp. 1081–1086). Oxford University Press (OUP). https://doi.org/10.1093/bjs/znac249