Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis

World Journal of Surgical Oncology

Research

Emile Farah¹  Patricio M. Polanco¹  Javier Salgado¹  Herbert J. Zeh¹  Benjamin Rail¹  Georgios Karagkounis¹  Andres A. Abreu¹ 

[1] Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, 75390, Dallas, TX, USA;

关键词: Colorectal cancer;    Colorectal surgery;    Robotic;    Laparoscopic;   

DOI  :  10.1186/s12957-023-03138-y

 received in 2023-05-31, accepted in 2023-08-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundRobotic colorectal surgery is becoming the preferred surgical approach for colorectal cancer (CRC). It offers several technical advantages over conventional laparoscopy that could improve patient outcomes. In this retrospective cohort study, we compared robotic and laparoscopic surgery for CRC using a national cohort of patients.MethodsUsing the colectomy-targeted ACS-NSQIP database (2015–2020), colorectal procedures for malignant etiologies were identified by CPT codes for right colectomy (RC), left colectomy (LC), and low anterior resection (LAR). Optimal pair matching was performed. “Textbook outcome” was defined as the absence of 30-day complications, readmission, or mortality and a length of stay < 5 days.ResultsWe included 53,209 out of 139,759 patients screened for eligibility. Laparoscopic-to-robotic matching of 2:1 was performed for RC and LC, and 1:1 for LAR. The largest standardized mean difference was 0.048 after matching. Robotic surgery was associated with an increased rate of textbook outcomes compared to laparoscopy in RC and LC, but not in LAR (71% vs. 64% in RC, 75% vs. 68% in LC; p < 0.001). Robotic LAR was associated with increased major morbidity (7.1% vs. 5.8%; p = 0.012). For all three procedures, the mean conversion rate of robotic surgery was lower than laparoscopy (4.3% vs. 9.2%; p < 0.001), while the mean operative time was higher for robotic (225 min vs. 177 min; p < 0.001).ConclusionsRobotic surgery for CRC offers an advantage over conventional laparoscopy by improving textbook outcomes in RC and LC. This advantage was not found in robotic LAR, which also showed an increased risk of serious complications. The associations highlighted in our study should be considered in the discussion of the surgical management of patients with colorectal cancer.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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