Surgical and medical outcomes in robotic compared to laparoscopic colectomy global prospective cohort from the American college of surgeons national surgical quality improvement program

Abstract

Background: Evidence regarding the outcomes benefits of robotic approach, when compared to a laparoscopic approach, in colectomy remain limited.

Objective: This study aimed to analyze the value of robotic approach compared to laparoscopic approach in minimally invasive colectomy.

Design: Cohort study of the National Surgical Quality Improvement Program (NSQIP).

Setting: This study included data from the NSQIP from 1/2016 to 12/2021.

Patient: Adult patients undergoing minimally invasive (laparoscopic or robotic) colorectal surgery.

Intervention: Robotic versus laparoscopic colectomy.

Outcome measures: Risk ratios for the incidence of medical and surgical morbidity and overall mortality.

Results: Compared to laparoscopic, robotic colectomy was associated with a significant decrease in postoperative morbidity [RR 0.84 (95%CI 0.72-0.96), P < 0.001], a significant reduction in postoperative mortality [RR 0.83 (95%CI 0.79-0.90), P 0.010)], and in post operative ileus [RR: 0.80 (95%CI 0.75-0.84), P < 0.001]. Yet, robotic approach was associated with a significant increase in total operative time despite a significant decrease in total length of stay. No benefit was observed regarding anastomotic leak.

Limitations: Observational nature of the study cannot exclude residual bias.

Conclusions: In this prospective cohort from the NSQIP, robotic colectomy was associated with a significant reduction in postoperative ileus, unplanned conversion to open surgery, morbidity, and overall mortality when compared to laparoscopic colectomy.

Keywords: Colectomy; Colon cancer; Laparoscopic; Minimally invasive; Rectal cancer; Robotic.