Benchmarking to validate the implementation of a robotic colorectal cancer surgery program. Proposal for a new method...

Benchmarking facilitates the assessment of surgical quality by comparing outcomes with standards of excellence. However, robotic colorectal cancer surgery (RCCS) benchmarks remain limited. The objective of this study is to assess whether the outcomes of our RCCS program meet benchmark standards and to propose a new method to create benchmarks. We conducted a retrospective observational study of 97 patients with colorectal tumors who underwent robot-assisted surgery between June-2019 and May-2024. Results for rectal cancer (n = 45), colon cancer (n = 47), and a subgroup of right hemicolectomy (n = 24) were analyzed. Results were compared with published benchmarks and additional references we created from published data, using a new method. For rectal cancer, our results were within the benchmark limits established by Staiger et al. Compared to the benchmark based on the meta-analysis by Khajeh et al., mortality, anastomotic leak, conversion rate, mean hospital stay, mesorectal integrity, circumferential margin, R0 resection rate, lymph nodes retrieved, and operative time all met the established limits. Overall and severe morbidity were similar to the 75th percentile (33% vs. 32.9%; 11.1% vs. 10.2%; respectively), while the reoperation rate was slightly higher (11.1% vs. 6.9%). For right hemicolectomy, results were within the established benchmark limits except for operative time. Benchmarking is a useful method to validate a RCCS program. Its implementation in a low-volume center can be safe. Further benchmark studies in this field are needed. In the absence of validated benchmarks, the method we propose may generate valuable references.