Predictors of Utilization and Quality Assessment in Robotic Rectal Cancer Resection: A Review of the National Cancer Database

Abstract

Robotic surgery (RS) is a novel treatment for rectal cancer resection (RCR); however, this technology is not widely accessible. The objective of this study is to evaluate the utilization of RS in RCR compared with open and laparoscopic techniques and to assess the quality of resection. RCR from 2010 to 2012 were identified using the National Cancer Database and placed into categories: open, laparoscopic, and robotic. A total of 23,857 patients who received open, laparoscopic, and robotic RCR were included (n = 14,735 (61.8%); 7,185 (30.1%); 1,937 (8.1%), respectively). Patients over 70 had a lower likelihood of robotic RCR. Patients with insurance were 2 times more likely to have robotic RCR. Patients at an academic/research program were more likely to undergo RS compared with a community cancer program (OR 3.6, 95% CI [2.79, 4.78]; P < 0.0001). Length of stay (LOS) was longer in open (7.9 ± 7.1) versus laparoscopic (6.6 ± 6.3) or robotic (6.8 ± 6.4) RCR (P < 0.0001). Although there was an increased likelihood of positive surgical margins with open RCR (OR 1.3, 95% CI [1.09, 1.66]; P < 0.0001), there was no difference in robotic and laparoscopic techniques. Younger insured patients at academic/research affiliated hospitals have a higher likelihood of receiving robotic RCR. Compared with open RCR, robotic RCR have a lower likelihood of positive surgical margins and shorter LOS.

Robotic Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta‐Analysis with Trial Sequential Analysis

“…4). Similarly, in the subgroup of non‐RCTs (44 OS [4–7, 16, 17, 34, 37, 38, 40, 42–46, 48, 51, 52, 55, 56, 59, 61–64, 66–68, 70–72, 74–78, 80, 83, 85–87, 89–91], 40,085 patients), the all‐cause mortality rate was significantly lower in RAS group ( ρ < 0.001, I 2 = 10%; OR 0.47; 95% CI 0.35, 0.63). However, in the subgroup of RCTs (4 RCTs [12, 13, 39, 79], 729 patients), all‐cause mortality rate in RAS was similar to CLS group ( ρ = 0.98; OR 0.97; 95% CI 0.14, 6.98).…”

“…The clinical characteristics of all included studies are illustrated in Table 1. The majority of them [3,6,12,14,16,17, were single-center, and 12 (1 RCT [13] and 11 observational studies [2,4,5,7,[86][87][88][89][90][91][92]) were multicenter. Among all the included studies, 53 studies (4 RCTs [12][13][14]32], 49 non-RCTs [4, 5, 7, 16, 17, 31, 33-37, 40, 42, 44, 47-49, 51, 52, 56, 60, 62-72, 78, 80-91]) compared the benefits of RAS versus CLS in rectal cancer, 11 (1 RCT [79], 10 non-RCTs [3,6,38,43,45,50,58,59,74,92]) in colon cancer and 9 (1 RCT [39], 8 non-RCTs [2, 41, 53-55, 57, 61, 77]) in colorectal cancer.…”

“…The estimated intraoperative blood loss was reported in 37 studies [6, 14, 16, 31, 34, 36–38, 42, 43, 46–49, 51–53, 55, 56, 59, 62, 63, 66–69, 72, 73, 77, 79–81, 83, 85, 86, 89, 90] (4508 patients). This meta‐analysis demonstrated that RAS group was associated with significant lower intraoperative blood loss as compared to the CLS arm ( ρ = 0.01, I 2 = 88%; REM: MD − 18.05; 95% CI − 32.24, − 3.85; ml) (eFigure 2).…”

“…This meta‐analysis demonstrated that RAS group was associated with significant lower intraoperative blood loss as compared to the CLS arm ( ρ = 0.01, I 2 = 88%; REM: MD − 18.05; 95% CI − 32.24, − 3.85; ml) (eFigure 2). In the subgroup of non‐RCTs (35 OS [6, 16, 31, 34, 36–38, 42, 43, 46–49, 51–53, 55, 56, 59, 62, 63, 66–69, 72, 73, 77, 80, 81, 83, 85, 86, 89, 90], 4299 patients), the intraoperative blood loss was significantly lower in RAS than CLS ( ρ < 0.001, I 2 = 85%; MD − 25.23; 95% CI − 38.88, − 11.57). In the subgroup of RCTs (2 RCTs [14, 79], 209 patients), both CLS and RAS had no significant difference in the estimated intraoperative blood loss ( ρ = 0.43, I 2 = 98%; MD 87.93; 95% CI − 128.62, 304.49).…”

“…In comparison to the CLS arm, the duration of hospital stay was significantly shorter in RAS (59 studies [2–4, 6, 7, 13, 14, 16, 17, 31–39, 42–52, 55, 56, 58, 59, 61–64, 66, 68–73, 75, 77–81, 83–91], 150,083 patients; ρ < 0.001, I 2 = 94%; REM: MD − 0.77; 95% CI, − 1.12, − 0.41; days), with substantial degree of heterogeneity (eFigure 3). In the subgroup of non‐RCTs (54 OS [2–4, 6, 7, 16, 17, 31, 33–38, 42–52, 55, 56, 58, 59, 61–64, 66, 68–73, 75, 77, 78, 80, 81, …”