Abstract
Background
Robotic colorectal cancer surgery is widely accepted and applied. However, there is still no objective and comprehensive assessment on the data of nationwide multicenter series.
Method
A total of 28 medical centers in Mainland China participated in this nationwide retrospective observational study. From the first case performed in each center to the last until December 2017, patients with robotic resection for primary tumor and pathologically confirmed colorectal adenocarcinoma were consecutively enrolled. Clinical, pathological and follow-up data were collected and analyzed.
Results
A total of 5389 eligible patients were finally enrolled in this study, composing 72.2% of the total robotic colorectal surgery volume of Mainland China in the same period. For resections of one bowel segment of primary tumor, the postoperative mortality rate was 0.08% (4/5063 cases), and the postoperative complication rate (Clavien–Dindo grade II or higher) was 8.6% (434/5063 cases). For multiple resections, the postoperative mortality rate was 0.6% (2/326 cases), and the postoperative complication rate was 16.3% (53/326 cases). Out of 2956 patients receiving sphincter-preserving surgery in only primary resection, 130 (4.4%) patients had anastomotic leakage. Traditional low anterior resection (tumor at middle rectum) (OR 2.384, P < 0.001), traditional low anterior resection (tumor at low rectum) (OR 1.968, P = 0.017) and intersphincteric resection (OR 5.468, P = 0.006) were significant independent risk factors for anastomotic leakage. Female gender (OR 0.557, P = 0.005), age ≥ 60 years (OR 0.684, P = 0.040), and preventive stoma (OR 0.496, P = 0.043) were significant independent protective factors. Body mass index, preoperative chemotherapy/radiotherapy, tumor size, and TNM stage did not independently affect the occurrence of anastomotic leakage.
Conclusion
Robotic colorectal cancer surgery was safe and reliable and might have advantages in patients at high risk of anastomotic leakage.
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Acknowledgements
Thanks to Intuitive Surgical—Fosun Medical Technology (Shanghai) Co., Ltd, for providing data support on the number of da Vinci® systems and the volume of surgery in Mainland China. Thanks to American Journal Experts for English language editorial service.
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Jianmin Xu, Bo Tang, Taiyuan Li, Baoqing Jia, Hongliang Yao, Ren Zhao, Weitang Yuan, Ming Zhong, Pan Chi, Yanbing Zhou, Xiongfei Yang, Longwei Cheng, Yulong He, Yongxiang Li, Weidong Tong, Xuejun Sun, Zhiwei Jiang, Kang Wang, Xiaorong Li, Xin Wang, Ye Wei, Zongyou Chen, Xiaoqiao Zhang, Yingjiang Ye, Fanghai Han, Kaixiong Tao, Dalu Kong, Ziqiang Wang, Cheng Zhang, Guodong He, and Qingyang Feng have no conflicts of interest or financial ties to disclose.
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Xu, J., Tang, B., Li, T. et al. Robotic colorectal cancer surgery in China: a nationwide retrospective observational study. Surg Endosc 35, 6591–6603 (2021). https://doi.org/10.1007/s00464-020-08157-4
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DOI: https://doi.org/10.1007/s00464-020-08157-4