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Laparoscopic vs Robotic surgery for obstructing colon cancer - a National Surgical Quality Improvement Program
Paola Solis-Pazmino1, Vincent Xu2, Rachel Ma3
1The Surgery Group of Los Angeles, Los Angeles, CA, United States; CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador.
Background:
Despite screening, approximately one-third of patients with colon cancer (CC) present with obstructing tumors. The effectiveness of robotic surgery in managing obstructing colon lesions compared with laparoscopic surgery remains uncertain. This study aimed to compare the effectiveness of robotic surgery compared with laparoscopic surgery in managing obstructing colon lesions using a large national database.
Methods:
A retrospective analysis of obstructing CC cases from the National Surgical Quality Improvement Program database (2016-2022) was conducted. Patients were categorized based on a laparoscopic or robotic surgical approach. A 3:1 propensity score matching was used to balance demographic and clinical characteristics. The primary outcomes included 30-day postoperative complication rates. The secondary outcomes included operative time, conversion rates, length of stay, reoperation, and readmission rates.
Results:
Of 4692 patients, 4214 (89.8%) underwent laparoscopic surgery, and 478 (10.2%) underwent robotic surgery. After matching, 1350 laparoscopic and 450 robotic cases remained. No significant difference was observed in 30-day postoperative complication rates between the 2 approaches (21.8% in robotic surgery vs 25.3% in laparoscopic surgery; P =.15). Compared with laparoscopic surgery, robotic surgery was associated with significantly lower conversion rates (15.7% vs 8.4%, respectively; P <.001) and shorter median hospital stays (4 vs 3 days, respectively; P <.001) but longer operative times (182 vs 234 min, respectively; P <.001). The reoperation and anastomotic leak rates did not differ significantly. Multivariate regression analysis showed that robotic surgery was not correlated with a lower likelihood of postoperative complications (odds ratio, 0.83 [95% CI, 0.56-1.24]; P =.37).
Conclusion:
Robotic surgery for obstructing CC shows benefits in reduced conversion rates and shorter hospital stays, despite increased operative times. However, robotic surgery does not significantly decrease the overall incidence of postoperative complications.
Insights
Robotic surgery for obstructing colon cancer reduces conversion rates and hospital stays but does not significantly lower overall postoperative complications compared to laparoscopic surgery.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Obstructing colonic tumors affect one-third of patients with colonic cancer.
- The comparative effectiveness of robotic versus laparoscopic surgery for these lesions remains unclear.
Purpose of the Study:
- To compare the outcomes of robotic and laparoscopic surgery for obstructing colonic cancer.
- To evaluate postoperative complications, operative time, conversion rates, and length of stay.
Main Methods:
- Retrospective analysis of 4692 patients with obstructing colonic cancer from the NSQIP database (2016-2022).
- 3:1 propensity score matching to balance patient characteristics between laparoscopic and robotic groups.
- Primary outcome: 30-day postoperative complication rates. Secondary outcomes: operative time, conversion rates, length of stay, reoperation, and readmission.
Main Results:
- Post-matching, 1350 laparoscopic and 450 robotic cases were analyzed.
- No significant difference in 30-day postoperative complication rates (25.3% vs. 21.8%, p=0.15).
- Robotic surgery showed lower conversion rates (15.7% vs. 8.4%, p<0.001) and shorter hospital stays (4 vs. 3 days, p<0.001), but longer operative times (182 vs. 234 minutes, p<0.001).
Conclusions:
- Robotic surgery for obstructing colonic cancer offers benefits in reduced conversion rates and shorter hospital stays.
- Despite these advantages, robotic surgery does not significantly decrease overall postoperative complications.
- Further research may explore patient selection and long-term outcomes.
