Robotic-assisted surgery for left-sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study

Surg Endosc. 2024 May;38(5):2577-2592. doi: 10.1007/s00464-024-10749-3. Epub 2024 Mar 18.

Abstract

Introduction: There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS.

Methods: Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models.

Results: A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21-0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26-0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26-0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033).

Conclusions: The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.

Keywords: C-reactive protein; Colon cancer; Complications; Inflammation; LS surgery; Minimally invasive surgery; Outcomes; Rectal cancer; Robotic surgery.

MeSH terms

  • Aged
  • C-Reactive Protein* / analysis
  • C-Reactive Protein* / metabolism
  • Colectomy / methods
  • Female
  • Humans
  • Laparoscopy / methods
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Proctectomy / adverse effects
  • Proctectomy / methods
  • Rectal Neoplasms / surgery
  • Retrospective Studies
  • Robotic Surgical Procedures* / methods
  • Stress, Physiological
  • Treatment Outcome

Substances

  • C-Reactive Protein