Improved perioperative outcomes and reduced inflammatory stress response in malignant robotic-assisted colorectal resections: a retrospective cohort study of 298 patients

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.

Surgical stress response and long-term survival in robot-assisted versus laparoscopic surgery for colon cancer: a propensity matched nationwide cohort study

“…To our knowledge, no studies, including larger sample sizes, have examined the association between the surgical stress response and long-term survival induced by RAS or LAS. A retrospective cohort study including 298 patients undergoing RAS or LAS for colorectal cancer in a planned setting indicated that LAS was associated with a significantly increased CRP response in the early postoperative course (21).…”

“…A Cox proportional hazard regression model was used to verify any potential effect modification of the postoperative CRP response and long-term survival, stratified by a low postoperative CRP response ( < 80 mg/L) compared to the group with a high CRP response (≥ 80 mg/L) across postoperative day one to day three. The assumptions underlying this cut-off threshold stem from data obtained in an observational study comparing patients undergoing planned RAS versus LAS for colorectal cancer (21). Results of both the unadjusted and adjusted analyses following PS matching were presented, Fig 1 . A two-sided p-value < 0.05 was considered statistically significant.…”