TY - JOUR
T1 - Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer
T2 - a propensity score-matched analysis
AU - Farah, Emile
AU - Abreu, Andres A.
AU - Rail, Benjamin
AU - Salgado, Javier
AU - Karagkounis, Georgios
AU - Zeh, Herbert J.
AU - Polanco, Patricio M.
N1 - Funding Information:
The work of PMP was supported by a Eugene P. Frenkel, M.D. Scholar Award from the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. Drs. Emile Farah, Andres Abreu, Javier Salgado Pogacnik, Georgios Karagkounis, Herbert Zeh, and Mr. Benjamin Rail have no conflict of interest or financial ties to disclose.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Robotic 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. Methods: Using 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. Results: We 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). Conclusions: Robotic 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.
AB - Background: Robotic 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. Methods: Using 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. Results: We 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). Conclusions: Robotic 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.
KW - Colorectal cancer
KW - Colorectal surgery
KW - Laparoscopic
KW - Robotic
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U2 - 10.1186/s12957-023-03138-y
DO - 10.1186/s12957-023-03138-y
M3 - Article
C2 - 37644538
AN - SCOPUS:85168986263
SN - 1477-7819
VL - 21
JO - World Journal of Surgical Oncology
JF - World Journal of Surgical Oncology
IS - 1
M1 - 272
ER -