Robotic Surgery Provides Benefit Over Conventional Laparoscopy for CRC

“Robotic surgery for colectomies is quickly becoming the preferred approach due to its multiple benefits for the surgeon, which include better 3D visualization and a stable camera, improved dexterity and instrument control, and reduced fatigue and hand tremor,” according to Patricio M. Polanco, MD.

Robotic surgery appeared to be advantageous vs conventional laparoscopy for colorectal cancer (CRC), providing improved outcomes for both left and right colectomies, according to findings from a propensity score-matched analysis published in the World Journal of Surgical Oncology.¹

In particular, investigators reported that robotic surgery was associated with an increased rate of textbook outcomes (TOs) vs laparoscopy for both left (74.6% vs 68.1%) and right colectomies (71.0% vs 64.0%; P <.001), respectively; however, the same was not seen with low anterior resection (LAR). It appeared that the notable difference in outcomes was attributed to shorter length of hospital stay and fewer complications. Although complication rates did not appear to be lower in the robotic cohort according to the univariate analysis, it did result in higher TO rates, defined as a length of hospital stay of fewer than 5 days and absence of 30-day complications, readmission, or mortality.

“Robotic surgery for colectomies is quickly becoming the preferred approach due to its multiple benefits for the surgeon, which include better 3D visualization and a stable camera, improved dexterity and instrument control, and reduced fatigue and hand tremor,” according to study author Patricio M. Polanco, MD, in a press release on the findings.² “Prior to this study, however, there was little real-world evidence demonstrating its efficacy compared to laparoscopic techniques.”

Polanco is an associate professor of Surgery in the Division of Surgical Oncology and a member of the Harold C. Simmons Comprehensive Cancer Center, as well as the director of University of Texas Southwestern Medical Center’s Robotic Surgery Training Program and co-director of the Pancreatic Cancer Program.

According to investigators, an outcomes-based program was used to track and refine surgical care for patients with CRC based on 30-day outcomes.

“[ACS-NSQIP] collects data on more than 250 variables, including demographics, preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality,” the authors wrote.¹ “To ensure the highest quality standards, data are collected and maintained by a dedicated surgical clinical reviewer at each participating institution.”

Investigators behind the retrospective cohort study identified patients via current procedural terminology codes for colorectal procedures. This included elective robotic or laparoscopic resections with anastomosis for CRC. Cases with disseminated cancer, ascites, preoperative sepsis, ASA-5, ventilator dependence, and concurrent major procedures—hepatectomy or pancreatectomy—were excluded. Stratification was based on location of colon or rectal resection, including right-sided colectomy, left-sided colectomy, and LAR.

A total of 53,209 records made up the final study cohort, including 16,982 right colectomies, 19,201 left colectomies, and 17,026 LARs. Of these cases, laparoscopy and robotic approaches were used in 4704 vs 2352, 6246 vs 3123, and 4854 vs 4854, respectively.

Median operative time was noted as being longer in the robotic arm at 183 minutes compared with 134 minutes in the laparoscopic arm for right colectomies, as well as 202 minutes vs 154 minutes for left colectomies (P <.001). Additionally, the average number of lymph nodes resected in the robotic group was 23.84 compared with 22.57 in the laparoscopic group for right colectomies, as well as 21.70 vs 21.03 for left colectomies, respectively (P <.001). Additionally, receipt of robotic surgery was associated with a lower conversion rate vs the laparoscopy cohort for both right-sided (4.1% vs 8.5%) and left-sided procedures (5.2% vs 8.8%; P <.001).

In terms of post-operative outcomes, both respective cohorts had a similar incidence of anastomotic leak for both right-sided (1.9% vs 1.8%) and left-sided procedures (2.1% vs 1.8%).

In the LAR cohort, the median operating time was 246 minutes in the robotic arm compared with 201 minutes in the laparoscopic arm (P <.001). Additionally, the conversion rate in each respective arm was 3.9% vs 10.4% (P <.001). Each respective cohort had comparable incidences of bleeding transfusion (2.5% vs 2.9%; P = .189).

References

1. Farah E, Abreu AA, Rail B, et al. Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. W J Surg Oncol. 2023;21(272). doi:10.1186/s12957-023-03138-y
2. Robotic surgery is associated with improved outcomes for most colon cancer patients. News release. UT Southwestern Medical Center. January 4, 2024. Accessed January 10, 2024. https://bit.ly/3tMNhZo