ROBOTIC VS. LAPAROSCOPIC COLECTOMY FOR COLON CANCER: WHICH IS BETTER?
Vanita Ahuja1,2, Lucero G. Paredes*1,2, Melissa Perkal2,1
1Surgery, Yale School of Medicine, New Haven, CT; 2VA Connecticut Healthcare System, West Haven, CT
Introduction: Robotic surgery for colon cancer resection has comparable outcomes to laparoscopic approaches; however, these have been mostly limited to single-year or single-center cohorts. This study investigates robotic vs laparoscopic colectomy, focusing on differences in clinical outcomes across several years using a nationwide database.
Method: Using ACS NSQIP for patients who underwent elective robotic or laparoscopic colon cancer surgery from 2012-2020. Inverse probability weighting with regression adjustment (IPWRA) incorporating demographics, year, operative factors, BMI, smoking, steroid use, and comorbidities was used to adjust for differences in patients in order to examine the relationship between surgical approach and 30-day mortality. Secondary outcomes included complications, return to the operating room (OR), postoperative length of stay (LOS), and operative time.
RESULTS: From 2012-2020, 83,841 patients underwent elective robotic or laparoscopic colectomy procedures for colon cancer. The mean age was 65 years old, 48% female, 65% White, 55% ASA3, and 36% BMI ≥ 30. Robotic procedures steadily increased from 0.02% in 2012 to 19.1% in 2020 (Figure 1). Patients who underwent a robotic procedure were younger, more likely to be male and non-Hispanic white, with a higher BMI, and fewer medical comorbidities. Overall there were 772 (0.92%) deaths, 14,159 (16.9%) patients with complications, and 3,219 (3.8%) patients who returned to OR. Mean (SD) LOS was 5.1 (4.4) days and mean (SD) operative time was 194 (96) minutes. After adjustment, robotic and laparoscopic surgery had similar 30-day mortality and complication rates, but robotic surgery had greater return to OR, shorter LOS, and longer operative times (Table 1).
CONCLUSIONS: Robotic approach for elective colon cancer resection has similar outcomes to its laparoscopic counterpart in relation to differences in peri-operative mortality or rate of complications. Robotic cases have a shorter length of stay overall, and longer operative time. Further investigation is imperative to better understand the potential impact of technological advancements such as robotic surgery on patient outcomes.
Robotic vs. laparoscopic approach to elective colectomy for patients with colon cancer (2012-2020)
Comparing robotic vs. laparoscopic colectomy outcomes (2012-2020)
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