Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Laparoscopic vs Robotic surgery for obstructing colon cancer - a National Surgical Quality Improvement Program database analysis.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Solis-Pazmino Paola, Xu Vincent, Ma Rachel, Chilla Sriya, Cohen Jason, Barnajian Moshe, Nasseri Yosef
Аннотация
BACKGROUND: Despite screening, approximately one-third of patients with colon cancer (CC) present with obstructing tumors. The effectiveness of robotic surgery in managing obstructing colon lesions compared with laparoscopic surgery remains uncertain. This study aimed to compare the effectiveness of robotic surgery compared with laparoscopic surgery in managing obstructing colon lesions using a large national database.
METHODS: A retrospective analysis of obstructing CC cases from the National Surgical Quality Improvement Program database (2016-2022) was conducted. Patients were categorized based on a laparoscopic or robotic surgical approach. A 3:1 propensity score matching was used to balance demographic and clinical characteristics. The primary outcomes included 30-day postoperative complication rates. The secondary outcomes included operative time, conversion rates, length of stay, reoperation, and readmission rates.
RESULTS: Of 4692 patients, 4214 (89.8%) underwent laparoscopic surgery, and 478 (10.2%) underwent robotic surgery. After matching, 1350 laparoscopic and 450 robotic cases remained. No significant difference was observed in 30-day postoperative complication rates between the 2 approaches (21.8% in robotic surgery vs 25.3% in laparoscopic surgery; P =.15). Compared with laparoscopic surgery, robotic surgery was associated with significantly lower conversion rates (15.7% vs 8.4%, respectively; P <.001) and shorter median hospital stays (4 vs 3 days, respectively; P <.001) but longer operative times (182 vs 234 min, respectively; P <.001). The reoperation and anastomotic leak rates did not differ significantly. Multivariate regression analysis showed that robotic surgery was not correlated with a lower likelihood of postoperative complications (odds ratio, 0.83 [95% CI, 0.56-1.24]; P =.37).
CONCLUSION: Robotic surgery for obstructing CC shows benefits in reduced conversion rates and shorter hospital stays, despite increased operative times. However, robotic surgery does not significantly decrease the overall incidence of postoperative complications.
METHODS: A retrospective analysis of obstructing CC cases from the National Surgical Quality Improvement Program database (2016-2022) was conducted. Patients were categorized based on a laparoscopic or robotic surgical approach. A 3:1 propensity score matching was used to balance demographic and clinical characteristics. The primary outcomes included 30-day postoperative complication rates. The secondary outcomes included operative time, conversion rates, length of stay, reoperation, and readmission rates.
RESULTS: Of 4692 patients, 4214 (89.8%) underwent laparoscopic surgery, and 478 (10.2%) underwent robotic surgery. After matching, 1350 laparoscopic and 450 robotic cases remained. No significant difference was observed in 30-day postoperative complication rates between the 2 approaches (21.8% in robotic surgery vs 25.3% in laparoscopic surgery; P =.15). Compared with laparoscopic surgery, robotic surgery was associated with significantly lower conversion rates (15.7% vs 8.4%, respectively; P <.001) and shorter median hospital stays (4 vs 3 days, respectively; P <.001) but longer operative times (182 vs 234 min, respectively; P <.001). The reoperation and anastomotic leak rates did not differ significantly. Multivariate regression analysis showed that robotic surgery was not correlated with a lower likelihood of postoperative complications (odds ratio, 0.83 [95% CI, 0.56-1.24]; P =.37).
CONCLUSION: Robotic surgery for obstructing CC shows benefits in reduced conversion rates and shorter hospital stays, despite increased operative times. However, robotic surgery does not significantly decrease the overall incidence of postoperative complications.