Introduction: The role of robotic resection in surgical oncology has increased dramatically in recent years. However, there is little available data regarding perioperative and oncological outcomes among robotic and laparoscopic colectomies when converted to open colectomies in colon cancer resection.
Methods: The National Cancer Data Base (NCDB) was used to identify patients who were diagnosed with adenocarcinoma of the colon, stages I-III from 2010-2020 who underwent subtotal colectomy. Patients underwent robotic-assisted colectomy (RA), robotic-assisted converted to open (RA-C), laparoscopic or endoscopic-assisted colectomy (MIS), laparoscopic or endoscopic-assisted converted to open (MIS-C), or open colectomy (OC). Multivariate regression modeling was used to compare outcomes among groups while adjusting for patient, clinical, and tumor characteristics.
Results: There was a total of 205,111 patients who underwent surgery. The most common surgical approach was open (43%), MIS (41%), and RA (9.2%). Only 0.7% and 6% were RA-C and MIS-C, respectively. After adjustment for patient and clinical characteristics, there was no significant difference in surgical margin outcomes between RA-C (R0: 93.4%, R1: 3.1%, R2: 0.3%) and OC (R0: 92.1%, R1: 3.6%, R2:0.6%) and MIS-C (R0: 91.8%, R1: 4%, R2: 0.7%) and OC. The hospital length of stay of RA-C (6.58 days) and MIS-C (7.14) was shorter than OC (7.66, p <.001). The 30- and 90-day mortality for RA-C (3% and 5.9% respectively) was significantly lower than in the OC group (5.4%, 9.2%, p = .023), but was not for MIS-C (3.6%, 7.1%) and OC. There was a significant difference in unplanned hospital readmission rates between RA-C (unadjusted rate: 5.8%) and OC (5.9%, p = .013) but not MIS-C (7.1%) and OC.
Conclusion: Conversion from robotic or laparoscopic to open colectomy was not associated with worse oncologic resection margins and yielded improved short-term outcomes. Robotic surgery, even when converted to open, was associated with improved short-term mortality.
