NEW HAVEN, CT — Elective colon cancer resection can be a good option for patients with localized malignancy. The goal is complete removal of the tumor, the major vascular pedicles, and the lymphatic drainage basin of the affected colonic segment.
But which is better: laparoscopic or robotic surgery? That is the question raised in a recent study from Yale University School of Medicine and the VA Connecticut Healthcare System in West Haven.
“Prior studies have shown comparable outcomes between laparoscopic and robotic approaches across a range of surgeries; however, these have been limited in size,” the authors wrote in the journal Surgical Endoscopy.1
In response, the study team sought to investigate differences in outcomes following robotic (RC) vs laparoscopic (LC) colectomy across several years utilizing a large national database. Data from ACS NSQIP was analyzed for patients who underwent elective minimally invasive colectomies for colon cancer from 2012 to 2020.
Taking into account demographics, operative factors, and comorbidities, the research analyzed outcomes including mortality, complications, return to the operating room (OR), post-operative length of stay (LOS), operative time, readmission, and anastomotic leak. The secondary analysis further assessed the anastomotic leak rate following right and left colectomies.
Of the 83,841 study participants who underwent elective minimally invasive colectomies, 14,122 (16.8%) had RC and 69,719 (83.2%) had LC. Patients who underwent RC were younger, more likely to be male, non-Hispanic White, with higher body mass index (BMI) and fewer comorbidities (for all, P < 0.05).
After adjustment, no differences were found between RC and LC for 30-day mortality (0.8% vs 0.9% respectively, P = 0.457) or overall complications (16.9% vs 17.2%, P = 0.432).
On the other hand, RC was associated with higher return to OR (5.1% vs 3.6%, P < 0.001), lower LOS (4.9 vs 5.1 days, P < 0.001), longer operative time (247 vs 184 min, P < 0.001), and higher rates of readmission (8.8% vs 7.2%, P < 0.001).
The study also determined that anastomotic leak rates were comparable for right-sided RC vs LC (2.1% vs 2.2%, P = 0.713), higher for left-sided LC (2.7%, P < 0.001), and highest for left-sided RC (3.4%, P < 0.001).
“Robotic approach for elective colon cancer resection has similar outcomes to its laparoscopic counterpart,” the authors wrote. “There were no differences in mortality or overall complications, however, anastomotic leaks were highest after left RC. Further investigation is imperative to better understand the potential impact of technological advancement such as robotic surgery on patient outcomes.”
VA data suggests that about a million veterans 50 and older will develop colorectal cancer in the remainder of their lives, and more than 400,000 will die of it. Nationally, the five-year survival rate for colorectal cancer in the VHA is about 40% compared to the general population’s survival rate of around 60%.
- Ahuja V, Paredes LG, Leeds IL, Perkal MF, King JT Jr. Clinical outcomes of elective robotic vs laparoscopic surgery for colon cancer utilizing a large national database. Surg Endosc. 2023 Sep;37(9):7199-7205. doi: 10.1007/s00464-023-10215-6. Epub 2023 Jun 26. PMID: 37365394.