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Robotic versus laparoscopic colectomy for stage I–III colon cancer: oncologic and long-term survival outcomes

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Abstract

Background

While short-term data suggest that robotic resections are safe for oncologic operations, long-term outcomes remain uncertain. This study evaluates the impact of robotic and laparoscopic approaches on oncologic and survival outcomes in partial and total colectomies for colon cancer.

Methods

The US National Cancer Database (2010–2012) was reviewed for patients with stage I–III adenocarcinoma of the colon, who underwent robotic and laparoscopic partial or total colectomies. Lymph node retrieval, surgical margins, and survival were compared between surgical approaches with linear and logistic regressions. Propensity score matching was then used to create comparable laparoscopic and robotic cohorts and compare survivor functions.

Results

Of 15,112 patients, 5.1% underwent robotic approaches (n = 765, conversion rate 10.6%), and 94.9% laparoscopic (n = 14,347, conversion rate 15.1%). Robotic approach was associated with Hispanic race (p = 0.009), private insurance (p = 0.001), and earlier stage (p = 0.028). There was no difference in number of lymph nodes retrieved (p = 0.6200) or negative surgical margins (p = 0.6700). In multivariate analysis, robotic approaches were associated with an improved hazard of mortality (HR 0.79, p = 0.027). Linear regression found no difference in lymph node retrieval (− 0.39, p = 0.285). Logistic regression found no difference in rates of positive margins (OR 1.09, p = 0.649). After propensity score matching, robotic approaches were associated with improved survival in stage II (5YS 66.9% vs. 56.8%, p = 0.0189) and III disease (5YS 78.6% vs. 64.9%, p = 0.0241).

Conclusion

Robotic approaches to partial and total colectomies for stage I–III colon cancer offer comparable oncologic outcomes as laparoscopic approaches. Relative to laparoscopic approaches, robotic approaches appear to offer improved long-term survival.

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Disclaimer

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Surgery, Division of Colon & Rectal Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, H137, Hershey, PA, 17033-0850, USA

    Katelin A. Mirkin, Audrey S. Kulaylat, Christopher S. Hollenbeak & Evangelos Messaris

  2. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA

    Christopher S. Hollenbeak

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  1. Katelin A. Mirkin
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  2. Audrey S. Kulaylat
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  3. Christopher S. Hollenbeak
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  4. Evangelos Messaris
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Correspondence to Evangelos Messaris.

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Disclosures

The authors Katelin A. Mirkin, Audrey S. Kulaylat, Christopher S. Hollenbeak, and Evangelos Messaris declare that they have nothing to disclose.

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Mirkin, K.A., Kulaylat, A.S., Hollenbeak, C.S. et al. Robotic versus laparoscopic colectomy for stage I–III colon cancer: oncologic and long-term survival outcomes. Surg Endosc 32, 2894–2901 (2018). https://doi.org/10.1007/s00464-017-5999-6

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  • DOI: https://doi.org/10.1007/s00464-017-5999-6

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