Robotic Versus Laparoscopic and Open Complex Oncologic Surgery: A Case Matched Study

Laura M Enomoto, MS, MD, Andrea Murray, MPH, Neil H Bhayani, MHS, MD, Niraj J Gusani, MS, MD, FACS, Joyce Wong, MD. Penn State Hershey Medical Center

Introduction. Robotic assisted surgery is a promising new minimally invasive approach to complex oncologic surgery, but concerns for adequacy of tumor resection, lymph node retrieval, and postoperative outcomes still remain.

Methods. This case matched study compared demographic, perioperative, and postoperative data of patients undergoing robotic assisted oncologic surgery to contemporaneous patients undergoing similar laparoscopic/open oncologic surgery at a tertiary cancer referral center between January 2009 and August 2014. Prospective databases of patients undergoing robotic, laparoscopic and open surgery were analyzed. All patients were de-identified prior to analysis.

Results. Twenty patients underwent robotic oncologic surgery and 19 patients underwent laparoscopic/open oncologic surgery. Of these 39 age and gender matched patients, 21 had disease of the pancreas, 16 gastric disease, and 2 had liver neoplasms. Thirteen (65%) patients who underwent robotic surgery were obese, while 8 (42%) patients who underwent laparoscopic/open surgery were obese (p=0.32). Median ASA class was 3 for both groups (p=0.29). Median anesthesia time for robotic cases was 312 minutes; median time for laparoscopic/open cases was 376 minutes (p=0.07). Estimated blood loss for robotic and laparoscopic/open cases was not significantly different (p=0.86). Three (15%) robotic cases were converted to open, and 5 of 11 (45%) laparoscopic cases were converted to open. One patient undergoing robotic surgery required pRBC transfusion (2 units) and 3 patients undergoing laparoscopic/open surgery required transfusion (2-5 units; p=0.25). Of the robotic cases, 7 (35%) patients had complications, while in the laparoscopic/open surgeries 8 (42%) patients had complications. Median Clavien-Dindo grade was II for both groups (p=0.41). Twelve (60%) patients undergoing laparoscopic/open surgery required ICU admission postoperatively compared to 6 (32%) patients undergoing robotic surgery (p=0.06). All patients undergoing robotic surgery were discharged to home, which was significantly different from the 15 (80%) patients undergoing laparoscopic/open surgery who were discharged to home; 4 (20%) in this group were sent to a rehabilitation or nursing facility (p=0.03). Although patients who underwent robotic surgery had a shorter median length of stay (4 days, range 3-13 days) versus patients who underwent laparoscopic/open surgery (5 days, range 1-22 days), this was not significant (p=0.20). Of the patients undergoing pancreatic surgery for adenocarcinoma, median tumor size was similar between robotic vs. laparoscopic/open cases (p=0.22). A median of 13 lymph nodes (range 11-17) were retrieved in robotic surgeries versus 28 (range 26-30) in laparoscopic/open surgeries (p=0.12). Median tumor size of patients undergoing gastric surgery for adenocarcinoma was similar between robotic and laparoscopic/open cases (p=1.0). A median of 20 lymph nodes (range 19-40) were retrieved in robotic surgeries; a median of 35 lymph nodes (range 32-42) were retrieved in laparoscopic/open cases (p=0.66). In patients undergoing pancreatic surgery for neuroendocrine tumors and gastric surgery for GIST, median tumor sizes were also not significantly different.

Conclusions. Robotic assisted oncologic surgery demonstrated similar peri- and postoperative outcomes and lymph node retrieval compared to laparoscopic/open oncologic surgery, demonstrating that robotic surgery may be a feasible approach for complex oncologic operations. Future study will be required to determine long-term oncologic outcomes and whether robotic surgery offers perioperative benefit.

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