Is the Postoperative Inflammatory Response Decreased in Robotic Compared with Laparoscopic Anterior Resection for...

To investigate postoperative inflammatory response as assessed by C-reactive protein (CRP) levels in patients undergoing anterior resection (AR) for rectal cancer by minimally invasive surgery (MIS).

All patients diagnosed with rectal cancer between 2011 and 2021 undergoing AR by MIS without conversion at one university hospital were included. Open surgery was not included. Patient data were obtained from the Swedish Colorectal Cancer registry and from local patient charts, including CRP levels preoperatively and postoperative day (POD) 1-5.

A total of 123 patients were identified with rectal cancer, of which the proportion of laparoscopic surgery (LAP) was 31% (n = 38) and robotic assisted rectal cancer surgery (ROBOT) 69% (n = 85). The proportion of women was 37%, median age 69, median body mass index 26, 25% had ASA class ≥3, 27% had neoadjuvant radiotherapy, 12% had neoadjuvant radiotherapy combined with chemotherapy, and 59% had a planned defunctioning stoma. No complications were noted in 44.7% of LAP and in 51.8% of ROBOT. Complications defined as Clavien-Dindo grade ≥IIIb were 10.5% in LAP and 9.4% in ROBOT. Hospital stay was a median 9.5 days in LAP and 10 in ROBOT. The median CRP values in LAP and ROBOT preoperatively were 3 and 4 (P = .845), on POD 1: 100 and 110 (P = .865); POD 2: 218 and 145 (P = .159); POD 3: 181 and 141 (P = .097); POD 4: 128 and 95 (P = .502), and on POD 5: 73 and 71 (P = .785), respectively.

Postoperative inflammatory response as assessed by postoperative CRP values was not statistically different between LAP and ROBOT. CRP levels on POD 2-4 were numerically lower in ROBOT. The clinical relevance of this finding warrants further investigation.