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Clinical outcomes of elective robotic vs laparoscopic surgery for colon cancer utilizing a large national database

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Prior studies have shown comparable outcomes between laparoscopic and robotic approaches across a range of surgeries; however, these have been limited in size. This study investigates differences in outcomes following robotic (RC) vs laparoscopic (LC) colectomy across several years utilizing a large national database.

Methods

We analyzed data from ACS NSQIP for patients who underwent elective minimally invasive colectomies for colon cancer from 2012 to 2020. Inverse probability weighting with regression adjustment (IPWRA) incorporating demographics, operative factors, and comorbidities was used. Outcomes included mortality, complications, return to the operating room (OR), post-operative length of stay (LOS), operative time, readmission, and anastomotic leak. Secondary analysis was performed to further assess anastomotic leak rate following right and left colectomies.

Results

We identified 83,841 patients who underwent elective minimally invasive colectomies: 14,122 (16.8%) RC and 69,719 (83.2%) LC. Patients who underwent RC were younger, more likely to be male, non-Hispanic White, with higher body mass index (BMI) and fewer comorbidities (for all, P < 0.05). After adjustment, there were no differences between RC and LC for 30-day mortality (0.8% vs 0.9% respectively, P = 0.457) or overall complications (16.9% vs 17.2%, P = 0.432). RC was associated with higher return to OR (5.1% vs 3.6%, P < 0.001), lower LOS (4.9 vs 5.1 days, P < 0.001), longer operative time (247 vs 184 min, P < 0.001), and higher rates of readmission (8.8% vs 7.2%, P < 0.001). Anastomotic leak rates were comparable for right-sided RC vs LC (2.1% vs 2.2%, P = 0.713), higher for left-sided LC (2.7%, P < 0.001), and highest for left-sided RC (3.4%, P < 0.001).

Conclusions

Robotic approach for elective colon cancer resection has similar outcomes to its laparoscopic counterpart. There were no differences in mortality or overall complications, however anastomotic leaks were highest after left RC. Further investigation is imperative to better understand the potential impact of technological advancement such as robotic surgery on patient outcomes.

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Funding

This article was made possible from support provided by the Veterans Affairs Office of Academic Affiliations, the Yale National Clinician Scholars Program, and by CTSA Grant Number TL1 TR001864 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH, the U.S. Department of Veterans Affairs, or the United States Government.

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Author notes

  1. Vanita Ahuja and Lucero G. Paredes have contributed equally to the preparation of this article and are co-first authors.

Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Vanita Ahuja, Ira L. Leeds & Melissa F. Perkal

  2. VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA

    Vanita Ahuja, Lucero G. Paredes, Ira L. Leeds, Melissa F. Perkal & Joseph T. King Jr

  3. National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, 06510-8088, USA

    Lucero G. Paredes

  4. Department of Surgery, Maine Medical Center, Portland, ME, USA

    Lucero G. Paredes

  5. Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA

    Joseph T. King Jr

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  1. Vanita Ahuja
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  2. Lucero G. Paredes
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Correspondence to Lucero G. Paredes.

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Disclosures

Lucero G Paredes is funded through the VA as a National Clinician Scholars Program (NCSP) Research Fellow at Yale University (see Funding for more details). Ira L Leeds served as a one-time consultant for Intuitive Surgical Inc. Vanita Ahuja, Melissa F Perkal, and Joseph T King Jr have no conflicts of interest or financial ties to disclose.

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Presented as an oral presentation at the 2023 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting in Montreal, Quebec, Canada on April 1, 2023.

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Ahuja, V., Paredes, L.G., Leeds, I.L. et al. Clinical outcomes of elective robotic vs laparoscopic surgery for colon cancer utilizing a large national database. Surg Endosc 37, 7199–7205 (2023). https://doi.org/10.1007/s00464-023-10215-6

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  • DOI: https://doi.org/10.1007/s00464-023-10215-6

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