Does prolonged operative time impact postoperative morbidity in patients undergoing robotic-assisted rectal resection for cancer?
Several studies have shown a correlation between longer operative times and higher rates of postoperative morbidity for open and laparoscopic surgery for rectal cancer. The aim of the study was to determine the impact of prolonged operative time on early postoperative morbidity in patients undergoing robotic-assisted rectal cancer resection.
The study was a retrospective review of a prospectively maintained database conducted in two centers of the same institution. A total of 260 consecutive patients undergoing with robotic-assisted resection for rectal cancer between 2007 and 2016 were included. Patients were divided into two groups regarding median operative time: > 300 min (prolonged operative time; n = 133) and ≤ 300 min (control; n = 127). Patient characteristics, operative and postoperative data were compared between groups. Univariate and multivariate analyses were performed to determine whether prolonged operative time was a predictive factor of 30-day postoperative morbidity.
Prolonged operative time was noted more frequently in males (p = 0.02), patients with higher BMI (p < 0.01), more severe comorbidities (p < 0.01), in tumors of the mid-rectum, and in surgery performed after neoadjuvant chemoradiation or upon surgeons’ learning curve. The two groups had similar overall postoperative morbidity (32 vs. 41%; p = 0.16) and severe morbidity (6 vs. 6%; p = 0.92) rates. Prolonged operative time was associated with longer hospital stay (3.8 ± 2.5 vs. 5.0 ± 3.7 days; p = 0.004) in univariate analysis. Prolonged operative time was not independently associated with postoperative morbidity or with increased hospital stay on multivariate analysis.
In our study, prolonged operative time was not associated with an over-risk of morbidity in patients undergoing robotic resection for rectal cancer. These results suggest that more difficult robotic procedures do not lead to increased postoperative morbidity.
KeywordsRobotic surgery Rectal cancer Operative time Proctectomy Postoperative morbidity
We thank the members of the ‘Fondation SanTDige’ for their support by a grant to Emilie Duchalais.
The ‘Fondation SanTDige’ provided a grant to Emilie Duchalais.
Compliance with ethical standards
Drs Emilie Duchalais, Nikolaos Machairas N, Scott R. Kelley, Ron G. Landman, Amit Merchea A, Dorin T. Colibaseanu, Kellie L. Mathis, Eric J. Dozois and David W. Larson have no conflicts of interest or financial ties to disclose.
- 1.van de Velde CJH, Boelens PG, Tanis PJ, Espin E, Mroczkowski P, Naredi P, Pahlman L, Ortiz H, Rutten HJ, Breugom AJ, Smith JJ, Wibe A, Wiggers T, Valentini V (2014) Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012. Eur J Surg Oncol 40:454–468. https://doi.org/10.1016/j.ejso.2013.10.013 CrossRefPubMedGoogle Scholar
- 2.Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MHGM., de Lange-de Klerk ESM, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332. https://doi.org/10.1056/NEJMoa1414882 CrossRefPubMedGoogle Scholar
- 4.Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, Choi HS, Kim D-W, Chang HJ, Kim DY, Jung KH, Kim T-Y, Kang GH, Chie EK, Kim SY, Sohn DK, Kim D-H, Kim J-S, Lee HS, Kim JH, Oh JH (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774. https://doi.org/10.1016/S1470-2045(14)70205-0 CrossRefPubMedGoogle Scholar
- 5.Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484. https://doi.org/10.1016/S1470-2045(05)70221-7 CrossRefPubMedGoogle Scholar
- 8.Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J, ALaCaRT I (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer. JAMA 314:1356. https://doi.org/10.1001/jama.2015.12009 CrossRefPubMedGoogle Scholar
- 9.Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PWT, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes. JAMA 314:1346. https://doi.org/10.1001/jama.2015.10529 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Colombo P-E, Bertrand MM, Alline M, Boulay E, Mourregot A, Carrère S, Quénet F, Jarlier M, Rouanet P (2016) Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal TME rectal approach? Ann Surg Oncol 23:1594–1600. https://doi.org/10.1245/s10434-015-5048-4 CrossRefPubMedGoogle Scholar
- 13.Lim DR, Bae SU, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2016) Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid–low rectal cancer following neoadjuvant chemoradiation therapy. Surg Endosc. https://doi.org/10.1007/s00464-016-5165-6 CrossRefPubMedGoogle Scholar
- 15.Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. JAMA 318:1569. https://doi.org/10.1001/jama.2017.7219 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Manceau G, Hain E, Maggiori L, Mongin C, Prost à la Denise J, Panis Y (2017) Is the benefit of laparoscopy maintained in elderly patients undergoing rectal cancer resection? An analysis of 446 consecutive patients. Surg Endosc 31:632–642. https://doi.org/10.1007/s00464-016-5009-4 CrossRefPubMedGoogle Scholar
- 22.NCCN.org NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) - Rectal cancer. Version 2.2016Google Scholar
- 23.Khreiss W, Huebner M, Cima RR, Dozois ER, Chua HK, Pemberton JH, Harmsen WS, Larson DW (2014) Improving conventional recovery with enhanced recovery in minimally invasive surgery for rectal cancer. Dis Colon Rectum 57:557–563. https://doi.org/10.1097/DCR.0000000000000101 CrossRefPubMedGoogle Scholar
- 24.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
- 31.Guend H, Widmar M, Patel S, Nash GM, Paty PB, Guillem JG, Temple LK, Garcia-Aguilar J, Weiser MR (2016) Developing a robotic colorectal cancer surgery program: understanding institutional and individual learning curves. Surg Endosc. https://doi.org/10.1007/s00464-016-5292-0 PubMedPubMedCentralCrossRefGoogle Scholar
- 32.Baukloh JK, Reeh M, Spinoglio G, Corratti A, Bartolini I, Mirasolo VM, Priora F, Izbicki JR, Gomez Fleitas M, Gomez Ruiz M, Perez DR (2017) Evaluation of the robotic approach concerning pitfalls in rectal surgery. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2016.12.014 CrossRefPubMedGoogle Scholar