Abstract
Background
Robotic-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study's main objective was to compare short-term complications, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robotic-assisted.
Methods
We conducted a retrospective cohort study comparing the robotic-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume centre from May 2017 – March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response.
Results
Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robotic-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4–5) versus 5 days, interquartile range (4–7), p < 0.001) and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robotic-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.20, 95% confidence interval (1.04–1.40), p < 0.001). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery and surgical or medical short-term complications.
Conclusion
Robotic-assisted surgery is feasible and can be safely implemented for colorectal resections. The robotic-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short and long-term outcomes of robotic surgery for colorectal cancer.
Improved perioperative outcomes and reduced inflammatory stress response in malignant robotic-assisted colorectal resections: a retrospective cohort study of 298 patients
