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Case Matched Comparison of Robotic Versus Laparoscopic Proctectomy for Inflammatory Bowel Disease
Ahmet Rencuzogullari*1, Emre Gorgun1, Meagan Costedio1, Erman Aytac1, Hermann Kessler1, Maher Abbas2, Feza H. Remzi1
1Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH; 2Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
Purpose: The utilization of robotic proctectomy (RP) for rectal cancer has recently gained popularity. Role of robotic surgery in patients with inflammatory bowel disease (IBD) remains unclear. The present study assesses peri- and postoperative results including ileal pouch-anal anastomosis (IPAA) outcomes in patients undergoing RP for IBD.
Methods: Between 01/2010 and 06/2014, patients who had robotic proctectomy for IBD were identified and case matched (1:1) with laparoscopic counterparts based on age, ASA score, diagnosis and type of procedure. Data were obtained from an IRB-approved, prospectively maintained institutional database.
Results: 21 patients undergoing RP fulfilled the study criteria and were matched with equal number of patients who had laparoscopic proctectomy (LP). Mean postoperative follow-up was 27.2 months. RP was associated with longer operating time (304 vs. 213 mins, p=0.01) and increased estimated blood loss (360 vs. 188, p= 0.002). The groups were comparable with respect to conversion rates (3 vs 4, p=>0.99). Time to first bowel movement (2 vs. 3, p=0.62), length of hospital stay (8 vs. 9, p=0.39), postoperative complications, IPAA related outcomes, Cleveland Clinic Global Quality of Life and SF-12 health survey outcomes (p>0.05) were similar between the two groups (table).
Conclusion: RP can safely be performed in IBD patients without worsening the postoperative complications and functional outcomes compared to laparoscopic surgery.
Patient demographics and results
| RS(n=21) | LS(n=21) | P-value | | Age (years) | 43 +/-15 | 44 +/- 13 | 0.86 | | Gender | | | 0.74 | | female n(%) | 6 (29%) | 7 (33%) | | | male n(%) | 15 (71%) | 14 (67%) | | | BMI | 28 +/-5 | 25 +/- 4 | 0.09 | | ASA Score | | | >0.99 | | I-II | 12 (57.1%) | 12 (57.1%) | | | III- IV | 9 (42.9%) | 9 (42.9%) | | | Diagnosis | | | >0.99 | | CD (n%) | 4 (19%) | 4 (19%) | | | UC (n%) | 17 (81%) | 17 (81%) | | | Procedure | | | >0.99 | | TPC n(%) | 4 (19%) | 4 (19%) | | | CP n(%) | 17 (81%) | 17 (81%) | | | Previous abdominal surgery | 9 (43%) | 5 (24%) | 0.2 | | Preoperative use of Anti-TNF agent | 2 (10%) | 1 (5%) | >0.99 | | Complications | | | | | Ileus | 6 (29%) | 5 (24%) | 0.73 | | Organ space SSI | 3 (14%) | 1 (5%) | 0.61 | | Urinary retention | 1 (5%) | 2 (10%) | >0.99 | | DVT | 1 (5%) | 1 (5%) | >0.99 | | Surgery related readmission | 5 (24%) | 5 (24%) | >0.99 | | CGQOL Total | 0.73 +/ 0.2 | 0.70 +/-0.1 | 0.78 | | SF12 PCS | 36 +/- 13 | 43 +/- 13 | 0.37 | | SF12 MCS | 46 +/- 10 | 57 +/- 7 | 0.16 |
BMI: Body Mass Index; ASA: American Society of Anesthesiologists; CD: Crohn's Disease; UC: Ulcerative Colitis; TPC: Total Proctocolectomy; CP: Completion Proctectomy;TNF: Tumor Necrosis Factors: SSI: Surgical Site Infection; DVT: Deep Vein Thrombosis; CGQOL: Cleveland Global Quality Of Life; PCS: Physical Component Summary; MCS: Mental Component Summary.
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