Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center

Abstract

BACKGROUND As a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient. AIM To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC. METHODS In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated. RESULTS Among 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection ( P < 0.001) and level III American Society of Anesthesiologists (ASA) score ( P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection ( P < 0.001) and comorbidities ( P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection ( P = 0.002) and multiple bowel resection ( P = 0.027) were independent risk factors. Multiple organ resection ( P < 0.001) and level III ASA score ( P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery. CONCLUSION Multiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.

Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar

“…Rektum kanserinde laparoskopik aşağı anterior rezeksiyon sonrası postoperatif komplikasyonların uzun dönem onkolojik sonuçlara etkisinin incelendiği gözlemsel bir çalışmada (n=686) majör postoperatif komplikasyon gelişme oranı %16,5 olarak belirlenmiştir 10 . KRK'lı hastalarda robotik cerrahi sonrası postoperatif komplikasyonların incelendiği retrospektif bir çalışmada (n=1040) majör postoperatif komplikasyon oranı %2,4 olarak bulunmuştur 8 . Huang ve ark.…”

“…Huang ve ark. 'nın çalışmasına benzer pek çok klinik çalışmada, robotik cerrahi sonrası hasta sonuçlarının açık ve laparoskopik cerrahiden daha iyi olduğu bilinmektedir, bu durum bu çalışmada görülen düşük komplikasyon oranını açıklamaktadır 8,23,24 .…”

“…Uzun süreli hastanede kalış, postoperatif komplikasyonlar, daha kötü hasta iyileşmesi ve artan sağlık bakım maaliyetleri ile ilişkilendirilen önemli faktörlerden biridir. Literatürde kolorektal cerrahiye ilişkin yapılan birçok çalışmada komplikasyon gelişen bireylerin hastanede kalış süresinin uzun olduğu görülmektedir [8][9][10]34 . Çalışmada da beklendiği gibi, hastanede kalış süresi majör komplikasyon gelişen hastalarda gelişmeyenlere göre daha uzundu.…”

Elective robotic partial colon and rectal resections: series of 170 consecutive robot procedures involving the Da Vinci Xi robot by a community general surgeon

“…14 Speci cally for robotic colectomy, a study of 1040 patients undergoing surgery for colorectal cancer, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8% and 3.5%, respectively. 15 Anastomotic leaks, a serious complication, have been reported with varying rates in the literature. In our study, there were 3 anastomotic leaks out of 159 anastomoses created or 1.9%.…”

Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A meta-analysis spanning 2004 to 2022

“…Abdominal surgeries often entail significant visceral trauma, presenting an enduring challenge for clinicians due to the subsequent emergence of postoperative complications. Within the realm of general surgery, the postoperative complication rates vary: Pancreaticoduodenectomy exceeds 40%[ 1 ], hepatectomy hovers around 38%[ 2 ], gastrectomy ranges from 10% to 15%[ 3 ], and colorectal resection is approximately 12%[ 4 ]. The incidence of postoperative complications is intricately linked to both patient-specific conditions and the intricacies of clinical treatment processes.…”