Obese patients and robotic colorectal surgery: systematic review and meta-analysis

Abstract

Background: Obesity is a major health problem, demonstrated to double the risk of colorectal cancer. The benefits of robotic colorectal surgery in obese patients remain largely unknown. This meta-analysis evaluated the clinical and pathological outcomes of robotic colorectal surgery in obese and non-obese patients. Methods: MEDLINE, Embase, Global Health, Healthcare Management Information Consortium (HMIC) and Midwives Information and Resources Service (MIDIRS) databases were searched on 1 August 2018 with no language restriction. Meta-analysis was performed according to PRISMA guidelines. Obese patients (BMI 30 kg/m 2 or above) undergoing robotic colorectal cancer resections were compared with non-obese patients. Included outcome measures were: operative outcomes (duration of surgery, conversion to laparotomy, blood loss), postoperative complications, hospital length of stay and pathological outcomes (number of retrieved lymph nodes, positive circumferential resection margins and length of distal margin in rectal surgery). Results: A total of 131 full-text articles were reviewed, of which 12 met the inclusion criteria and were included in the final analysis. There were 3166 non-obese and 1420 obese patients. A longer duration of surgery was documented in obese compared with non-obese patients (weighted mean difference −21⋅99 (95 per cent c.i. −31⋅52 to −12⋅46) min; P < 0⋅001). Obese patients had a higher rate of conversion to laparotomy than non-obese patients (odds ratio 1⋅99, 95 per cent c.i. 1⋅54 to 2⋅56; P < 0⋅001). Blood loss, postoperative complications, length of hospital stay and pathological outcomes were not significantly different in obese and non-obese patients. Conclusion: Robotic surgery in obese patients results in a significantly longer duration of surgery and higher conversion rates than in non-obese patients. Further studies should focus on better stratification of the obese population with colorectal disease as candidates for robotic procedures.

Review article: obesity and colorectal cancer

“…Focusing on oncologic colorectal surgery, a more recent meta‐analysis of 13 observational studies (4550 patients) reported significant increased conversion rate (OR: 2.11; 1.58–2.81), postoperative morbidity (OR: 1.54; 1.21–1.97), wound infection (OR: 2.43; 1.46–4.03), and anastomotic leak (OR: 1.65; 1.01–2.71) in the obese group 82 . On the contrary to what has been described for other cancers, 82–84 the rate of positive margin (distal and circumferential), 5‐year disease‐free and overall survival, 82 do not convincingly differ between normal‐weight and patients with obesity after laparoscopic, 82 or robotic, 84 surgery.…”

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

“…There were no other significant differences in intra-or post-operative outcomes. The second meta-analysis performed by Suwa et al 28 found a significantly increased operative time and rate of conversion to laparotomy in OB patients. However, given the differences in pathology, surgical treatment, and multimodal treatment between rectal and colon cancer, 29 it is important to investigate colon cancer as a separate disease process.…”

“…There were no other significant differences in intra‐ or post‐operative outcomes. The second meta‐analysis performed by Suwa et al 28 . found a significantly increased operative time and rate of conversion to laparotomy in OB patients.…”

Robotic versus laparoscopic right hemicolectomy: a case-matched study

“…It has been demonstrated that obese patients pose a greater technical challenge for minimally invasive colorectal surgery as they tend to have a thicker mesentery and larger omentum, which can result in impaired vision, restricted space for instruments to manoeuvre, distorted surgical planes and troublesome bleeding [17,18]. For these reasons, the RRH cohort likely posed a greater technical challenge than the less obese LRH cohort, which may have contributed to the longer operating time in patients managed by robotic surgery [18][19][20]. However, it is interesting to note that, despite the potential greater technical challenge posed by those undergoing RRH, the well-recognised higher complication rate associated with obese patients was not observed, with equivalent post-operative outcomes to those that underwent LRH.…”