Differences in Effectiveness and Use of Robotic Surgery in Patients Undergoing Minimally Invasive Colectomy

Abstract

Background We compared patient outcomes of robot-assisted surgery (RAS) and laparoscopic colectomy without robotic assistance for colon cancer or nonmalignant polyps, comparing all patients, obese versus non-obese patients, and male versus female patients. Methods We used the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program data to examine a composite outcome score comprised of mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus. We used propensity scores to assess potential heterogeneous treatment effects of RAS by patient obesity and sex. Results In all, 17.1% of 10,844 of patients received RAS. Males were slightly more likely to receive RAS. Obese patients were equally likely to receive RAS as non-obese patients. In comparison to nonRAS, RAS was associated with a 3.1% higher adverse composite outcome score. Mortality, reoperations, wound infections, sepsis, pulmonary embolisms, deep vein thrombosis, myocardial infarction, blood transfusions, and average length of hospitalization were similar in both groups. Conversion to open surgery was 10.1% lower in RAS versus nonRAS patients, but RAS patients were in the operating room an average of 52.4 minutes longer. We found no statistically significant differences (p > 0.05) by obesity status and gender. Conclusions Worse patient outcomes and no differential improvement by sex or obesity suggest more cautious adoption of RAS.

Adaptation of robotic surgery for colorectal cancer in a regional university

“…This poses the question: why doesnʼt robotic surgery benefit colon surgery? We should also emphasize that Schootman et al 1) presented data from multiple institutes and that profiles of the surgeons involved were not available. In contrast, the latter studies were conducted at single institutes where the surgeons have extensive experience.…”

“…Schootman et al recently compared the short-term results of robotic surgery and conventional laparoscopic surgery for treating colon diseases 1) . Data for a total of 2233 robotic and 10 844 conventional laparoscopic surgeries performed between 2013 and 2015 were obtained from the National Surgical Quality Improvement Program (NSQIP).…”

“…Difficult cases are more likely to be treated by experts, and more short communication challenging cases are apt to be referred to centralized hospitals. We are deeply concerned that the statistical analysis conducted by Schootman et al 1) on 13 077 patients did not take into consideration surgical expertise or other indicators of surgical quality. Therefore, the results might have hidden the real benefits of robotic surgery.…”

“…Even if robotic surgery really causes only one additional complication in 32 surgically treated patients 1) , this is enough to impel strict guidelines for utilizing this procedure. If robotic surgery can be performed with a safety profile that is equivalent and/or superior to conventional laparoscopic surgery, then the surgical approach chosen should be based on the preferences of both surgeon and patient.…”

“…Hence, the use of robotic surgery to treat colorectal cancer in our institute seems feasible so far. However, furtherance of robotic surgery requires solid evidence of this technique's real benefits.Schootman et al recently compared the short-term results of robotic surgery and conventional laparoscopic surgery for treating colon diseases 1) . Data for a total of 2233 robotic and 10 844 conventional laparoscopic surgeries performed between 2013 and 2015 were obtained from the National Surgical Quality Improvement Program (NSQIP).…”