Robotic-assisted surgery for left sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study

Ingham,, A. R. et al. (2024) Robotic-assisted surgery for left sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study. Surgical Endoscopy, (doi: 10.1007/s00464-024-10749-3) (PMID:38498212)

Abstract

Introduction: There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS. Methods: Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models. Results: A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21-0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26-0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26-0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033). Conclusions: The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mansouri, Mr David and Mackay, Mr Graham and Chong, Dr David and McSorley, Dr Stephen and Roxburgh, Professor Campbell and Alani, Mr Ahmed and McMillan, Professor Donald and Kong, Dr Chia Yew
• Authors: Ingham,, A. R., Kong, C. Y., Wong, T.-N., McSorley, S. T., McMillan, D. C., Nicholson, G. A., Alani, A., Mansouri, D., Chong, D., Mackay, G. J., and Roxburgh, C. S.D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Surgical Endoscopy
• Publisher: Springer
• ISSN: 0930-2794
• ISSN (Online): 1432-2218
• Published Online: 18 March 2024
• Copyright Holders: Copyright © The Author(s) 2024
• First Published: First published in Surgical Endoscopy 2024
• Publisher Policy: Reproduced under a Creative Commons licence