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DO OUTCOMES AFTER UNPLANNED CONVERSION DIFFER FOR PATIENTS UNDERGOING ROBOTIC WHEN COMPARED WITH LAPAROSCOPIC COLECTOMY?
Ahmed M. Al-Mazrou*, Ravi P. Kiran
Surgery - Colorectal Surgery Division, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY
Background/Purpose: The robotic approach improves the feasibility of minimally invasive colectomy even in locations that may otherwise be an anatomic challenge with laparoscopy. Whether a failure in the completion of colectomy with this newer technology is then associated with worse consequences should also be considered when one evaluates the relative benefit of robotic colectomy. The aim of this study is to evaluate rates of conversion to open surgery after robotic and laparoscopic colectomy and whether outcomes after conversion vary after the two techniques since this has not been well studied.
Methods: From the American College of Surgeons (ACS) - National Surgical Quality Improvement Program (NSQIP) (2015-2016), patients who underwent elective minimally invasive colectomy were identified. Converted robotic were compared to laparoscopic procedures for patient demographics, co-morbidities; primary procedure and diagnosis, concurrent (colorectal and non-colorectal) procedures, prolonged operation and postoperative complications.
Results: Of 36,046 colectomy procedures, 30,808 (85.5%) were laparoscopic, while 5,238 (14.5%) were robotic-assisted. There were 3,271 (9.1%) conversions to open surgery (laparoscopic: 2,959 [9.6%]; robotic: 312 [6%]). Male gender, colorectal malignancy, diverticular disease and preoperative chemotherapy were associated with robotic conversion. However, inflammatory bowel disease was associated with laparoscopic conversion. Robotic conversion tended to occur during left colectomy, while right, other partial and total abdominal colon resections were higher for converted laparoscopic procedures. Thirty-day postoperative surgical site infection (15.7% vs. 13.3%, p=0.2), anastomotic leak (3.8% vs. 3.8%, p=1.0), ileus (19.7% vs. 20.5%, p=0.7), sepsis/septic shock (6.7% vs. 5.1%, p=0.2), bleeding requiring transfusion (9.9% vs. 9.8%, p=0.9), urinary tract infection (2.9% vs. 2.6%, p=0.7), reoperation (7.4% vs. 5.4%, p=0.2); pulmonary (5.1% vs. 3.4%, p=0.1), renal (2.9% vs. 1.5%, p=0.1), cardiac/cerebrovascular (1.3% vs. 1.7%, p=0.6) complications; readmission (14.4% vs. 11.6%, p=0.1), hospital stay (mean [SD], days: 7.1 [6.2] vs. 7.4 [7.1], p=0.4) and mortality (1.9% vs. 1.5%, p=0.5) were similar between the two groups. However, deep vein thrombosis/pulmonary embolism was higher after robotic conversion (4.5% vs. 2.2%, p=0.01).
Conclusion: Conversion was lower after robotic when compared to laparoscopic colectomy. Different factors were associated with conversion after the two techniques, however, patients had similar outcomes except for vein thromboembolism which was higher after robotic conversion. Robotic technology seems to improve the feasibility of minimally invasive surgery without negatively affecting safety and efficacy even when conversion is required.
Thirty-day complications, mortality and hospital stay after converted robotic versus laparoscopic colectomy
| Variable | Robotic conversion
N= 312 | Laparoscopic conversion
N= 2,959 | p-value | | Surgical site infection | 49 (15.7%) | 393 (13.3%) | 0.2 | | Anastomotic leak | 12 (3.8%) | 113 (3.8%) | 1.0 | | Postoperative ileus | 61 (19.7%) | 605 (20.5%) | 0.7 | | Pulmonary complication | 16 (5.1%) | 101 (3.4%) | 0.1 | | Urinary tract infection | 9 (2.9%) | 76 (2.6%) | 0.7 | | Renal complication | 9 (2.9%) | 43 (1.5%) | 0.1 | | Sepsis or septic shock | 21 (6.7%) | 151 (5.1%) | 0.2 | | Deep vein thrombosis/Thrombophlebitis or Pulmonary embolism | 14 (4.5%) | 64 (2.2%) | 0.01 | | Bleeding requiring transfusion | 31 (9.9%) | 289 (9.8%) | 0.9 | | Cardiac/cerebrovascular complication | 4 (1.3%) | 50 (1.7%) | 0.6 | | Unplanned reoperation | 23 (7.4%) | 160 (5.4%) | 0.2 | | Unplanned readmission | 45 (14.4%) | 342 (11.6%) | 0.1 | | Mortality | 6 (1.9%) | 43 (1.5%) | 0.5 | | Length of stay, day, Mean (SD) | 7.4 (7.1) | 7.1 (6.2) | 0.4 |
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