[Conversion to open surgery and short-term outcomes of laparoscopic versus robot-assisted minimally invasive definitive surgery for chronic radiation enteropathy].

Objective: To compare the conversion rate to open surgery and short-term outcomes between laparoscopic and robot-assisted minimally invasive definitive surgery for chronic radiation enteropathy (CRE). Methods: A retrospective cohort study was conducted. Clinical data of 69 patients with CRE scheduled for minimally invasive definitive surgery at Beijing Tsinghua Changgung Hospital, Tsinghua University, between June 2023 and December 2025 were retrospectively analyzed. Forty-four patients were initially planned for laparoscopic surgery and 25 for robotic surgery; the conversion rates to open surgery were compared between the two groups. Pelvic adhesions were stratified into low-risk (41 patients) and high-risk (28 patients) categories, and the correlation between adhesion risk and conversion to open surgery was analyzed. Perioperative parameters were compared between patients who successfully completed laparoscopic surgery (30 patients) and those who completed robotic surgery (24 patients). Results: Among the 69 patients in the group, 15 cases (21.7%) were converted to open surgery. The conversion rates to open surgery in the planned laparoscopic surgery group and the planned robotic surgery group were 31.8% (14/44) and 4.0% (1/25), respectively (χ2=7.25, P=0.007); The conversion rates of high-risk and low-risk pelvic adhesion patients to open surgery were 42.9% (12/28) and 7.3% (3/41), respectively (χ2=12.35, P<0.001). Among those who have completed minimally invasive surgery, the robot surgery group has a higher baseline complexity. The median surgical time for the laparoscopic surgery group and the robotic surgery group were 207 (180,278) minutes and 310 (238,350) minutes, respectively (Z=2.65, P=0.008). The median intraoperative blood loss was 15 (10, 20) ml and 20 (20, 31) ml, respectively (Z=3.23, P=0.001); The median postoperative length of hospital stay was longer in the robotic surgery group [11 (9, 14) days vs. 15 (12, 21) days, Z=2.79, P=0.004], and the median total hospitalization cost was higher [86.6 (69.5, 109.3) thousand yuan vs. 134.2 (124.4, 144.8) thousand yuan, Z=4.37, P<0.001]. The overall incidence of complications in the laparoscopic surgery group and the robotic surgery group were 23.3% (7/30) and 37.5% (9/24), respectively. The incidence of complications with Clavien Dindo grade ≥ III was 10.0% (3/30) and 12.5% (3/24), respectively, and the differences were not statistically significant (all P>0.05). Conclusion: The planned robotic approach is associated with a lower conversion rate to open surgery compared with the planned laparoscopic approach. Among patients completing minimally invasive surgery, robotic surgery is performed on cases with higher complexity and consumes more medical resources, without an increase in postoperative complications.