COMPARISON OF ROBOTIC-ASSISTED VERSUS CONVENTIONAL LAPAROSCOPIC COLECTOMY FOR COLORECTAL CANCER: A MULTICENTER OUTCOMES ANALYSIS

Abstract

Background: The use of robotic surgery in colorectal surgery has grown in volume, but the benefit of using robotic surgery over laparoscopy for colectomy in CRC is still under discussion as the advantage of the robotic surgery may be offset by longer operative time and increased cost. This multi-center outcomes study compared peri- and oncologic quality measures between robotic-assisted and conventional laparoscopic colectomy. Methods: A retrospective cohort of 486 non-metastatic colorectal cancer (CRC) patients who underwent elective minimally invasive colectomy (MIC) at four tertiary hospitals. 198 patients who underwent robotic-assisted colectomy, 288 patients underwent conventional laparoscopic colectomy. The primary outcome was a composite of 30-day major morbidity, conversion to open surgery or inadequate oncologic specimen. Secondary outcomes were operative time, blood loss, lymph node yield, margin status, length of stay, readmission, and 90-day initiation of adjuvant chemotherapy if indicated. Results: There were no differences between groups in baseline age, sex, tumour stage or burden of comorbidities. Robotic colectomy had longer operative time (214.5 +/- 52.8 vs. 174.2 +/- 45.6 minutes, p<0.001), but lower estimated blood loss (82.6 +/- 49.4 vs. 126.8 +/- 72.5 mL, p<0.001) and lower conversion rate (3.0% vs. 8.7%, p=0.015). There was no difference in overall complications (18.2% vs. 22.6%, p=0.25) and a lower, although not statistically significant, rate of major morbidity after robotic surgery (5.6% vs. 9.7%, p=0.10). Lymph node yield was higher in the robotic group (24.8 +/- 8.1 vs. 21.9 +/- 7.4, p<0.001), and R0 resection was achieved in 98.5% versus 96.2% (p=0.17). The composite adverse outcome was seen in 12.1% of the robotic cases and 22.2% of the laparoscopic cases (p=0.005). Conclusions: Robotic-assisted colectomy was significantly correlated with fewer composite adverse outcomes, higher lymph node yield, less blood loss and fewer conversions, but with a longer operating time. Patient selection and cost-effectiveness assessment are still crucial.