A National Cancer Database Analysis of the Trends in Conversion from Robotic-Assisted Proctectomy to Laparotomy in...

Background: Robotic-assisted proctectomy (RAP) has been reportedly associated with lower rates of conversion to laparotomy than laparoscopy in several cohort studies. This st0udy aimed to assess the temporal trends in conversion from RAP to laparotomy stratified by patient and treatment-related factors. Methods: This retrospective observational study was undertaken to analyse the temporal trends in unplanned conversion from RAP to laparotomy. Changes in the rates of conversion over time were plotted as line graphs, and the significance of each trend was calculated with the Cochran-Armitage trend test. A case-control analysis of factors associated with conversion to open surgery was conducted. Results: The study included 23,644 patients (62.3% male, median age: 60 years). 1280 (5.4%) patients were converted to laparotomy. There was a significant linear trend of decreased conversion over time (3.9% in 2021 compared with 10.4% in 2010; P < .001). The reduction in conversion rates was significant in all patients except in patients <50 years (P = .838), Black patients (P = .358), patients with a Charlson comorbidity index score >1 (P = .053), patients with governmental insurance other than Medicaid and Medicare (P = .629), and patients undergoing abdominoperineal resection (APR) (P = .129) or pelvic exenteration (PE) (P = .326). The independent predictors for increased conversion were male sex, higher Charlson scores, community cancer programs, comprehensive community cancer programs, household income of <$63,000, tumors ≥5 cm, and PE. Conclusions: Unplanned conversion from RAP to laparotomy showed a linear trend of reduction over time, which was statistically significant except in young patients, Black patients, patients with significant comorbidities, and patients undergoing APR or PE.