Robotic surgery may offer significant benefits over laparoscopic procedures in patients with colorectal cancer undergoing colectomies, according to a recent study published by Farah et al in the World Journal of Surgical Oncology. These findings suggest that a majority of patients receiving robotic surgery may experience improved outcomes.
Background
“Robotic surgery for colectomies is quickly becoming the preferred approach due to its multiple benefits for the surgeon, which include better [three-dimensional] visualization and a stable camera, improved dexterity and instrument control, and reduced fatigue and hand tremor,” explained senior study author Patricio M. Polanco, MD, Associate Professor of Surgery in the Division of Surgical Oncology; Director of the Robotic Surgery Training Program; Co-Director of the Pancreatic Cancer Program; and a member of the Harold C. Simmons Comprehensive Cancer Center at The University of Texas Southwestern Medical Center. “Prior to this study, however, there was little real-world evidence demonstrating its efficacy compared [with] laparoscopic techniques,” he emphasized.
Although both robotic and laparoscopic surgeries are considered minimally invasive and use small incisions and a camera to view the procedure, surgeons performing laparoscopy manually manipulate the tools and use a thin telescopic rod outfitted with a tiny two-dimensional laparoscope to view the surgical site, whereas surgeons performing robotic surgery have a control console to maneuver the robotic arms outfitted with surgical tools. The more advanced technology of robotic surgery not only may create a higher-quality three-dimensional view of the procedure but may also offer better precision and range of motion and eliminate any hand tremors by the surgeon.
Study Methods and Results
In the recent retrospective study, investigators used the 2015 to 2020 American College of Surgeons National Surgical Quality Improvement Program database to identify 53,209 colectomy cases across the United States. The investigators sought to compare the outcomes achieved by robotic and laparoscopic surgeries.
Colorectal procedures were identified by location: right and left colectomies—which comprise the majority of colorectal cancer surgeries—and low anterior resections involving the rectum. The investigators noted that a textbook outcome was defined as the absence of 30-day complications, readmission, and mortality as well as a postoperative length of stay of fewer than 5 days.
They found that 71% of the robotic procedures for right colectomies resulted in textbook outcomes compared with 64% of the laparoscopic treatments. The results were similar for left colectomies at 75% vs 68%, respectively.
Further, the investigators discovered that the patients who had robotic surgery may have had shorter hospital stays, lower rates of complications, more lymph nodes harvested, more accurate cancer staging, fewer conversions to open surgery necessitated by anatomic challenges, and fewer instances of postoperative ileus.
Only the patients receiving low anterior resection experienced better outcomes with laparoscopic surgery. In these cases, those who had robotic surgery experienced higher rates of postoperative ileus (11.9% vs 10.5%), hospital readmissions (10.4% vs 9.1%), and major morbidity (7.1% vs 5.8%), with comparable rates of textbook outcomes (68% vs 67%). Although the factors contributing to the discrepancy were not able to be determined in this study, the investigators indicated that small differences favoring laparoscopic surgery corresponded to the higher complexity of rectal resections and surgeons’ longer experience with the procedure.
Conclusions
“The growth in robotic surgery and the alarming increase in colorectal cancer in younger adults are two of the most significant trends we have seen in recent years, both of which highlight the importance of optimizing surgical treatment strategies,” Dr. Polanco underscored. “These findings are critical because they give us a deeper understanding of the benefits and drawbacks of robotic surgery and can help patients and their surgical teams make informed decisions regarding their treatment,” he concluded.
Disclosure: The research in this study was supported by the Eugene P. Frenkel, MD, Scholar Award from the Harold C. Simmons Comprehensive Cancer Center. For full disclosures of the study authors, visit wjso.biomedcentral.com.
