Laparoscopic Versus Robotic Left-sided Colectomy with Low Pelvic Anastomosis: An Assessment From the ACS-NSQIP Procedure-targeted Cohort

Cigdem Benlice, Emre Gorgun, Meagan Costedio, Luca Stocchi, Maher Abbas, Feza Remzi. Cleveland Clinic, Department of Colorectal Surgery

Introduction: Robotic surgery is increasingly performed in the management of left-sided colonic and rectal pathologies. In this study, perioperative outcomes of patients who underwent laparoscopic versus robotic left colectomy with low pelvic anastomosis were compared using the procedure-targeted database.

Methods and Procedures: Data regarding patients who had elective left-sided colectomy were retrieved from the 2013 procedure-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into two groups based on the type of surgical approach: Laparoscopic vs. Robotic. Demographics, comorbidities, perioperative and 30-day outcomes were compared between the groups. 

Results: A total of 3484 patients undergoing laparoscopic and robotic left colectomy were identified. There were 3150(90.4%) patients in laparoscopic and 334(9.6%) in robotic group. Groups were comparable in terms of preoperative characteristics and comorbidities except for final diagnosis (p=0.004) and dyspnea (4.9vs.2.4%,p=0.04). Robotic surgery was associated with longer operating times, but also decreased conversion rates and hospital stay when compared to laparoscopic surgery. Overall morbidity and mortality were comparable between groups(Table). After adjusting for  confounder, conversion rates became statistically comparable  [OR:0.78(CI:0.51-1.20),p=0.27)] while robotic surgery remained associated with longer  operative times [OR:0.90(CI:0.80-0.95),p<0.001] but also reduced hospital stay[OR:1.21(CI:1.10-1.30),p<0.001].

Conclusion: Robotic surgery has similar short-term outcomes when compared to laparoscopic approach with additional benefit of shorter hospital stay in patients undergoing left-sided colectomy with low pelvic anastomosis. 

Table. Comparison of perioperative and 30-day outcomes between the laparoscopic and robotic groups

 
 

Laparoscopic

(N=3150)

Robotic

(N=334)

P-value
Operative time*,minutes 211±92 253 ±119

<0.001

Conversion to open 436(13.8%) 33(9.9%) 0.04
Hospital stay*,days 6±5.8 5.1±3.8 <0.001
Superficial SSI 144(4.6%) 14(4.2%) 0.75
Deep SSI 16(0.5%) 2(0.6%) 0.69
Organ-space SSI 126(4.0%) 15(4.5%) 0.67
Bleeding requiring transfusion 172(5.5%) 15(4.5%) 0.46
Ventilator dependency 28(0.9%) 1(0.3%) 0.52
Ileus 301(9.6%) 28(8.4%) 0.49
Anastomotic leak 115(3.7%) 12(3.6%) 0.96
Readmission 287(9.1%) 34(10.2%) 0.52
Reoperation 127(4.0%) 14(4.2%) 0.89
Morbidity 680(21.6%) 73(21.9%) 0.91
Mortality 17(0.5%) 2(0.6%) 0.70

 

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