P18: Perioperative Outcomes of Robotic and Laparoscopic Surgery for Colorectal Cancer: A Propensity Score Matched Analysis

Friday, March 24, 2023

10:36 AM – 10:41 AM

Location: SSO HUB Pan-Tumor Zone: CRS, HPB, Pan-Tumor & Upper GI

Poster Presenter(s)

Emile Farah, MD

Postdoctoral Research Fellow
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure information not submitted.

Author(s)

Andres A. Abreu, MD (he/him/his)

Postdoctoral Researcher
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s): No financial relationships to disclose
BR

Benjamin Rail, n/a

Medical Student
UT Southwestern Medical Center, United States

Disclosure information not submitted.
Giorgos Karakousis, MD

Professor of Surgery
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
JS

Javier Salgado Pogacnik, MD

Associate Professor
UT Southwestern Medical Center, United States

Disclosure information not submitted.
Herbert J. Zeh, III, MD

Chair of Surgery
UT Southwestern Medical Center
Dallas, TX, United States

Disclosure information not submitted.
Patricio M. Polanco, MD

MD
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Andres A. Abreu, MD: No financial relationships to disclose

Patricio M. Polanco, MD: No financial relationships to disclose

Introduction: Robotic colorectal surgery is becoming the favorable surgical approach for colorectal cancer (CRC). Compared to laparoscopy, robotic surgery offers several technical advantages that could improve outcomes. There is limited data reporting the perioperative outcomes of these two surgical approaches in the management of CRC. In this study, we aim to compare perioperative outcomes of robotic and laparoscopic surgery for CRC using a nationally representative clinical database.

Methods: Using the colectomy-targeted ACS-NSQIP database (2015-2020), we identified colorectal procedures for malignant etiologies using CPT codes. We included right colectomy (RC), left colectomy (LC), and low anterior resection (LAR). After estimating the conditional probability of undergoing robotic surgery (propensity score), optimal pair matching was performed. We defined textbook outcomes (TO) as: absence of 30-day mortality, no complications or return to OR, length of stay < 5 days (75^th percentile), no readmission. We used a multivariate logistic regression to estimate the average treatment effect. Data were matched and analyzed using R Foundation^®.

Results: Out of 234,304 colectomy cases screened for eligibility, our final cohort included 53,209 patients. Laparoscopic to robotic 2:1 optimal pair matching was performed for RC and LC, and 1:1 for LAR. Matched datasets were evaluated for baseline covariate balance and homogeneity. The largest standardized mean difference was 0.048 in matched data sets. Multivariate regression analysis showed an improvement in textbook outcomes (OR= 1.4 p< .001) favoring robotic over laparoscopic in RC and LC, but not in LAR (Figure 1). Robotic LAR was associated with increased severe complications (OR=1.2 p< 0.001). For all three procedures, the mean robotic conversion rate (3.1%) was significantly lower than the mean laparoscopic conversion rate (9.23%) (OR= 0.5 p< 0.001). The mean operative time (OT) was significantly longer in robotic (225 minutes) compared to laparoscopy (mean= 177 minutes) (OR=1.3 p< 0.001).

Conclusions: Robotic surgery for CRC offers an advantage over conventional laparoscopic surgery by improving textbook outcomes in right and left colectomy. This advantage is not seen in robotic LAR, which also showed an increased risk of severe complications. For all three procedures, the robotic approach was associated with a longer operative time, but a lower conversion rate. Our future efforts will aim to explore and compare the long-term outcomes of robotic and laparoscopic CRC surgery.

Learning Objectives:

make an informed decision about the management of colorectal cancer
understand the differences between robotic and laparoscopic surgery outcomes
design future studies and clinical trials to provide more evidence in the field