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Trends and outcomes of robotic surgery for gastrointestinal (GI) cancers in the USA: maintaining perioperative and oncologic safety

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Abstract

Objective

Minimally invasive surgery (MIS) continues to gain traction as a feasible approach for the operative management of gastrointestinal (GI) malignancies. The aim of this study is to quantify national trends, perioperative and oncologic outcomes of MIS for the most common GI malignancies including the esophagus, stomach, pancreas, colon, and rectum. We hypothesize that with more widespread use of MIS techniques, perioperative outcomes and oncologic resection quality will remain preserved.

Methods

The National Cancer Database (2010–2014) was utilized to assess perioperative outcomes and pathologic quality of MIS (robotic and laparoscopic) compared to open, in patients who underwent resection for cancers of the esophagus, stomach, pancreas, colon, and rectum. Multilevel logistic regression models were constructed to identify independent factors associated with postoperative and long-term outcomes.

Results

Data from 11,023 esophageal, 30,664 gastric, 30,689 pancreas, 260,669 colon, and 52,239 rectal resections were analyzed. Although laparoscopy is the most prevalent MIS approach, the number of robotic resections increased nearly fourfold from 2010 to 2014 in all organ sites (increase by factor: esophagus: 3.8, stomach: 4.4, pancreas: 4.4, colon: 3.8 and rectum: 4). The number of laparoscopic resections increased at a slower rate (factor: 1.3–1.9), whereas the number of open resections decreased (factor: 0.67–0.77). Patients who underwent robotic-assisted resections were younger for stomach and colorectal resections and with lower Charlson Comorbidity Index across all sites. Patients who underwent robotic or laparoscopic resections had shorter hospitalizations, fewer readmissions (with the exception of rectal resections) and lower postoperative mortality at 90 days. Robotic-assisted resections had comparable negative margin resections and number of lymph nodes to laparoscopic and open resections across all sites.

Conclusion

The utilization of robotic-assisted resections of GI cancers is rapidly increasing with more frequent use in younger and healthier patients. This study demonstrates that with the rising utilization of robotic-assisted resections, perioperative outcomes and oncologic safety have not been compromised.

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Authors and Affiliations

  1. Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA

    Ioannis T. Konstantinidis

  2. Department of Surgery, City of Hope National Medical Center, Medical Office Bldg., 1500 East Duarte Road, Duarte, CA, 91010, USA

    Philip Ituarte, Yanghee Woo, Susanne G. Warner, Kurt Melstrom, Jae Kim, Gagandeep Singh, Byrne Lee, Yuman Fong & Laleh G. Melstrom

Authors
  1. Ioannis T. Konstantinidis
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  2. Philip Ituarte
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  3. Yanghee Woo
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  4. Susanne G. Warner
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  5. Kurt Melstrom
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  6. Jae Kim
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  7. Gagandeep Singh
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  8. Byrne Lee
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  9. Yuman Fong
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  10. Laleh G. Melstrom
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Corresponding author

Correspondence to Laleh G. Melstrom.

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Disclosures

Dr. Yanghee Woo serves as Proctor and Course Head for Intuitive Surgical, is a Consultant for Ethicon and Verb Surgical, and serves as Surgeon Advisor for Titan Medical. Drs. Ioannis T. Konstantinidis, Philip Ituarte, Susanne G. Warner, Kurt Melstrom, Jae Kim, Gagandeep Singh, Byrne Lee, Yuman Fong, Laleh G. Melstrom, have no conflicts of interest or financial ties to disclose.

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Konstantinidis, I.T., Ituarte, P., Woo, Y. et al. Trends and outcomes of robotic surgery for gastrointestinal (GI) cancers in the USA: maintaining perioperative and oncologic safety. Surg Endosc 34, 4932–4942 (2020). https://doi.org/10.1007/s00464-019-07284-x

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  • DOI: https://doi.org/10.1007/s00464-019-07284-x

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