Prior abdominal surgery characteristics predict adhesion phenotype and adhesiolysis in robotic colorectal cancer resection while preserving short-term outcomes.

BACKGROUND

Prior abdominal surgery (PAS) is common in patients undergoing robotic colorectal cancer (CRC) resection. Most studies have evaluated PAS as a binary exposure, leaving unclear which specific PAS characteristics are associated with technically relevant adhesions, adhesiolysis, and operative efficiency in robotic surgery.

METHODS

This retrospective cohort study included 746 consecutive patients who underwent robotic CRC resection at a single institution between January 2018 and December 2025; 200 patients (26.8%) had a history of PAS. Among patients with PAS, associations between detailed PAS characteristics and intraoperative adhesion phenotype or adhesiolysis were assessed using multivariable regression analyses. Short-term outcomes between PAS and non-PAS patients were compared after 1:1 propensity score matching using age, sex, body mass index, American Society of Anesthesiologists physical status, preoperative treatment, primary tumor site, and clinical T stage.

RESULTS

In the PAS cohort, adhesions were observed in 46.0 and 36.0% required adhesiolysis. Cancer-related PAS (adjusted odds ratio [aOR] 3.78, 95% confidence interval [CI] 1.36-11.4; p = 0.01) and prior open surgery (aOR 6.06, 95% CI 2.47-16.9; p < 0.01) independently predicted abdominal wall adhesions. Among adhesion-positive PAS patients, middle (aOR 15.2, 95% CI 1.34-172.9; p = 0.02) and lower abdominal PAS (aOR 12.2, 95% CI 3.05-48.9; p < 0.01) independently predicted adhesiolysis. After matching, operative time, console time, blood loss, conversion, and severe complications were comparable between groups. Mean differences were small for operative time (16.2 min, 95% CI -8.5 to 40.9), console time (10.6 min, 95% CI -7.6 to 28.8), and blood loss (12.9 mL, 95% CI -7.4 to 33.2).

CONCLUSIONS

Specific PAS characteristics, rather than PAS presence alone, were associated with technically relevant adhesions and adhesiolysis in robotic CRC resection. Despite increased technical burden, short-term outcomes remained comparable, supporting a more individualized interpretation of prior surgical history in robotic colorectal surgery.