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

Emile Farah, Andres A. Abreu, Benjamin Rail, Javier Salgado, Georgios Karagkounis, Herbert J. Zeh, Patricio M. Polanco

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number272
JournalWorld Journal of Surgical Oncology
Volume21
Issue number1
DOIs
StatePublished - Dec 2023

Keywords

  • Colorectal cancer
  • Colorectal surgery
  • Laparoscopic
  • Robotic

ASJC Scopus subject areas

  • Surgery
  • Oncology

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