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Comparing pathologic outcomes for robotic versus laparoscopic Surgery in rectal cancer resection: a propensity adjusted analysis of 7616 patients

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Margin negative resection of rectal cancer with minimally invasive techniques remains technically challenging. Robotic surgery has potential advantages over traditional laparoscopy. We hypothesize that the difference in the rate of negative margin status will be < 6% between laparoscopic and robotic approach.

Methods

The National Cancer Database (2010–2014) was queried for adults with locally advanced rectal cancer who underwent neoadjuvant chemoradiation and curative resection to conduct an observational retrospective cohort study of a prospectively maintained database. Patients were grouped by either robotic (ROB) or laparoscopic (LAP) approach in an intent-to-treat analysis. Primary outcome was negative margin status, defined as a composite of circumferential resection margin and distal margin. Secondary outcomes included length of stay (LOS), readmission, 90-day mortality, and overall survival.

Results

7616 patients with locally advanced rectal cancer who underwent minimally invasive resection were identified. 2472 (32%) underwent attempted robotic approach. The overall conversion rate was 13% and was increased in the laparoscopic group [LAP: 15% vs. ROB: 8%; OR 0.47; 95% CI (0.39, 0.57)]. Differences in margin negative resection rate were within the prespecified range of practical equivalence (LAP: 93% vs.: ROB 94%; 95% CI (0.69, 1.06); \(p_{\updelta}\) = 1). For secondary outcomes, there was no difference in 30-day readmission [LAP: 9% vs.: ROB 8%; 95% CI (0.84, 1.24)] and 90-day mortality [LAP: 1% vs.: ROB 1%; 95% CI (0.38, 1.24)]. While the median LOS was 5 days in both groups, the mean LOS was 0.6 (95% CI: 0.24, 0.89) days shorter in the robotic group.

Conclusion

This robust analysis supports either robotic or laparoscopic approach for resection of locally advanced rectal cancer from a margin perspective. Both have similar readmission and 5-year overall survival rates. Patients undergoing robotic surgery have a 0.6-day decrease in LOS and decreased conversion rate.

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Acknowledgements

The authors thank Anne Zimmerman Hawkins for her proofreading.

Funding

Dr. Hawkins’ work on this manuscript was supported by the National Institute of Diabetes and Digestive and Kidney Disease of the National Institutes of Health under Award No. K23DK118192. The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. Additional support was provided by CTSA Award No. UL1 TR002243 from the National Center for Advancing Translational Sciences.

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Authors and Affiliations

  1. Section of Colon & Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Vanderbilt University, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA

    M. Benjamin Hopkins, Timothy M. Geiger, Alva J. Bethurum, Molly M. Ford, Roberta L. Muldoon, David E. Beck & Alexander T. Hawkins

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Thomas G. Stewart

Authors
  1. M. Benjamin Hopkins
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  2. Timothy M. Geiger
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  3. Alva J. Bethurum
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  4. Molly M. Ford
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  5. Roberta L. Muldoon
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  6. David E. Beck
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  7. Thomas G. Stewart
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Corresponding author

Correspondence to Alexander T. Hawkins.

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Disclosures

Dr. Geiger is a paid consultant for INX medical, which has no relevance to this study. Drs. Hopkins, Ford, Muldoon, Beck, Stewart and Hawkins & Mr. Bethurum have no financial ties to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators. Drs. Hopkins, Geiger, Ford, Muldoon, Beck, Stewart and Hawkins & Mr. Bethurum have no conflicts of interest to disclose.

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Hopkins, M.B., Geiger, T.M., Bethurum, A.J. et al. Comparing pathologic outcomes for robotic versus laparoscopic Surgery in rectal cancer resection: a propensity adjusted analysis of 7616 patients. Surg Endosc 34, 2613–2622 (2020). https://doi.org/10.1007/s00464-019-07032-1

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  • DOI: https://doi.org/10.1007/s00464-019-07032-1

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