Lower conversion rate with robotic assisted rectal resections compared with conventional laparoscopy; a national cohort study

Abstract

Background Conversion from laparoscopic to open access colorectal surgery is associated with a poorer postoperative outcome. The aim of this study was to assess conversion rates and outcomes after standard laparoscopic rectal resection (LR) and robotic laparoscopic rectal resection (RR). Methods A national 5-year cohort study utilizing prospectively recorded data on patients who underwent elective major laparoscopic resection for rectal cancer. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry. Primary end point was conversion rate. Secondary end points were postoperative complications within 30 days and histopathological results. Chi-square test, two-sided T test, and Mann–Whitney U test were used for univariable analyses. Both univariable and multivariable logistic regression analyses were used to analyze the relations between different predictors and outcomes, and propensity score matching was performed to address potential treatment assignment bias. Results A total of 1284 patients were included, of whom 375 underwent RR and 909 LR. Conversion rate was 8 out of 375 (2.1%) for RR compared with 87 out of 909 (9.6%) for LR (p < 0.001). RR was associated with reduced risk for conversion compared with LR (aOR 0.22, 95% CI 0.10–0.46). There were no other outcome differences between RR and LR. Factors associated with increased risk for conversion were male gender, severe cardiac disease and BMI > 30. Conversion was associated with higher rates of major complications (20 out of 95 (21.2%) vs 135 out of 1189 (11.4%) p = 0.005), reoperations (13 out of 95 (13.7%) vs 93 out of 1189 (7.1%) p = 0.020), and longer hospital stay (median 8 days vs 6 days, p = 0.001). Conclusion Conversion rate was lower with robotic assisted rectal resections compared with conventional laparoscopy. Conversions were associated with higher rates of postoperative complications.

A retrospective audit of Robotic versus Laparoscopic Anterior Resection for diverticular disease in a Single Surgeon’s Experience

“…Crippa et al [12] showed both techniques had similar rates of 30-day mortality. Similarly, Myrseth et al [14] also demonstrated that 30-day mortality did not differ between robotic-assisted resection and laparoscopic resection, which is consistent with other large studies [14]. This was similar in our study whereby there was no 30-day morbidity or mortality.…”

“…Conversion to open surgery is usually associated with more complications, longer hospital stays and poorer long-term outcomes [6,14]. Many studies have shown that robotic surgery is associated with signi cantly lower conversion rates as opposed to laparoscopic surgery in rectal cancers [4,12,14,19]. Our study also re ects this with a 0% conversion to open in the robotic group.…”

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

“…In an analysis of administrative data including patients who underwent right colectomy, investigators found that patients who underwent robotic as compared to laparoscopic surgery were significantly less likely to undergo conversion [ 4 ]. Similarly, data from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry also revealed lower conversion rates with robotic-assisted rectal resections compared with conventional laparoscopic resections [ 20 ]. In the same manner, meta-analyses of patients with lung cancer have similarly identified lower conversion to open surgery for patients who underwent robotic surgery as compared to video-assisted surgery [ 15 , 21 ].…”

“…In fact, for rectal, colon, and lung cancer, our data reveal substantial reductions in conversions across the board. Given that minimally invasive conversions are reportedly associated with higher rates of postoperative complications [ 20 ] and increased length of stay, we propose reductions in conversion as a potential mechanism for robotic length of stay improvement.…”

Learning Curve of Robotic-Assisted Total Mesorectal Excision for Rectal Cancer

“…Robotic platforms can overcome some limitations of conventional laparoscopic surgery, such as an immersive three-dimensional view of the surgical field, better dexterity capability, stable camera platform, and improved ergonomics for the surgeon (7). The safety and feasibility of robotic-assisted laparoscopic surgery for rectal cancer have been demonstrated by previously published studies (7)(8)(9)(10)(11); subsequently, the learning curve to determine how this technique can be taught to novices is also important to study. Although some studies have reported the learning curve of robotic-assisted laparoscopic surgery for rectal cancer (12)(13)(14)(15)(16)(17), most reports included limited sample sizes, which may be inadequate to achieve statistical significance and cannot evaluate the growth process of surgical techniques from a holistic perspective.…”