Robotic Surgery Boosts outcomes of Colorectal Cancer
In the evolving landscape of colorectal cancer (CRC) surgery, a recent retrospective cohort study underscores the growing preference for robotic procedures over conventional laparoscopy. The study concludes that robotic surgery for CRC offers clear advantages, particularly in right and left colectomies, by significantly improving textbook outcomes. This study was published in the World Journal Of Surgical Oncology by Emile Farah and colleagues.
Utilizing a national cohort of patients from the ACS-NSQIP database (2015–2020), the study aims to compare outcomes between robotic and laparoscopic approaches for colorectal cancer. Among 139,759 screened patients, 53,209 were included in the study, focusing on colorectal procedures for malignant etiologies, including right colectomy (RC), left colectomy (LC), and low anterior resection (LAR).
Matching and Outcomes:
Optimal pair matching, with a standardized mean difference of 0.048, was performed, comparing laparoscopic and robotic surgery outcomes.
"Textbook outcome" (absence of 30-day complications, readmission, or mortality, and length of stay < 5 days) was significantly higher with robotic surgery in RC and LC but not in LAR (71% vs. 64% in RC, 75% vs. 68% in LC; p < 0.001).
Complications and Conversion Rates:
Robotic LAR showed an increased risk of major morbidity (7.1% vs. 5.8%; p = 0.012).
Across all procedures, the mean conversion rate for robotic surgery was lower than laparoscopy (4.3% vs. 9.2%; p < 0.001).
Robotic surgery had a longer mean operative time compared to laparoscopy (225 min vs. 177 min; p < 0.001).
However, these advantages were not observed in robotic low anterior resection, which exhibited an increased risk of serious complications. Notably, robotic procedures showed a lower conversion rate but required more operative time compared to laparoscopy. The associations identified in the study contribute valuable insights to the ongoing discussion on the surgical management of colorectal cancer patients. Surgeons and healthcare professionals should weigh the benefits and potential risks associated with robotic surgery, especially when considering the specific procedure involved.
Reference:
Farah, E., Abreu, A. A., Rail, B., Salgado, J., Karagkounis, G., Zeh, H. J., III, & Polanco, P. M. Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. World Journal of Surgical Oncology,2023;21(1). https://doi.org/10.1186/s12957-023-03138-y
