Robotics on the rise, but not everywhere: National trends in robotic approach for colorectal cancer surgery

Minimally invasive surgical approaches, including laparoscopic and robotic techniques, have been shown to improve the outcomes in colorectal cancer resection by decreasing pain, hospital length of stay, and perioperative mortality. However, broader adoption of robotics faces several barriers. This study aimed to evaluate national trends in robotic colorectal surgery using the National Cancer Database (NCDB).

Patients with stage I to III colon and rectal adenocarcinomas who underwent resection (2010-2021) were identified. Trends in surgical approaches (open, laparoscopic, and robotic) were analyzed. Multivariate logistic regression identified factors associated with the adoption of robotics.

A total of 537,627 colon and 116,763 rectal resections were included. Robotics were used in 61,640 (11.5%) colon and 30,569 (26.1%) rectal cases. For colon cancer, the adoption of robotics increased by +2.4% annually, nearly equaling open surgery by 2021 (26.7% vs 27.2%). For rectal cancer, adoption of robotics increased by +4.28% annually, surpassing both laparoscopic and open approaches by 2018. Robotic surgery was predominantly performed in metropolitan centers (87.2%) compared with rural areas (1.5%). Regionally, the adoption of robotics was the highest in the West North Central (+5.0%/y) and West South Central (+3.3%/y) regions and the lowest in New England (+1.3%/y). Compared with New England, all regions were more likely to use robotics, with the West North Central region demonstrating the highest odds (odds ratio, 2.15 [95% CI, 1.95-2.38]).

Robotic colorectal cancer surgery has expanded substantially over the past decade, with marked regional and institutional disparities. Understanding these patterns may inform targeted educational initiatives and promote nationwide equitable adoption of robotic surgery.