ROBOTIC-ASSISTED RIGHT COLECTOMY DECREASES CONVERSION IN MINI-INVASIVE RIGHT COLECTOMY IN RIGHT COLON CANCER

Yuki Liu, MS¹, Emelline Liu, MSHS¹, Jorge A Lagares-Garcia, MD, FACS, FASCRS², Gabriel Chedister, MD³. ¹Intuitive Surgical, ²Roper Hospital, ³Medical University of South Carolina

OBJECTIVES: To evaluate the rate, risk factors and impacts of conversion to open right colectomy (ORC) for both traditional laparoscopic (LRC) and robotic-assisted right colectomy (RRC) performed for right colon cancer patients.

METHODS: Patients >18 with right colon cancer undergoing elective right colectomy as the primary procedure during 2013-2105Q3 were identified from Premier Perspective Database® using ICD-9-CM diagnosis and procedures codes. Three level analyses were conducted: (1) Unadjusted and Propensity-Score Matching (PSM) adjusted conversion rates were compared between LRC and RRC groups; (2) A multivariate logistics regression was used to quantify the effect of surgical modality on conversion adjusting for patient, surgeon, and hospital level risk factors of conversion to open; and (3)  impacts of conversion were assessed through comparing the 30-day perioperative outcomes and cost between the converted and non-converted groups.

RESULTS: There were 10,622 eligible patients during January 2013-September 2015. Among them, 6,024 patients underwent LRC and 662 patients underwent RRC.  Both unadjusted and PSM adjusted results suggest RRC had a significantly lower conversion rate than LRC (Unadjusted:  6.8% vs. 12.3% P= < 0.0001; adjusted:  6.7% vs. 11.2%, P=0.01). The multivariate logistic regression quantified that RRC was associated with a 47% decreased odds of conversion to ORC compared with LRC (adjusted odds ratio [OR] 0.53, 95% confidence interval [CI] 0.38-0.72). Other significant preventive factors of conversion included lower patient Charlson comorbid index/CCI, high volume surgeon, colorectal specialized surgeon, and simpler concomitant procedure such as cholecystectomy. Significant risk factors of conversion included BMI>40, male gender, other concomitant colorectal resection, and previous abdominal surgery. Comparing converted to non-converted patients, conversion was found to be associated with significantly higher perioperative complication (including surgical site infection), postoperative blood transfusion, 30-day complication related readmission, longer operative time and higher perioperative 30-day cost (All P values  <0.01).

CONCLUSION: Conversion to open surgery for right colon cancer patients is associated with higher perioperative complication, longer LOS, operation-room time and higher cost. Robotic assistance, high volume surgeon and surgeon with colorectal specialty are associated with decreased odds of conversion.

_{[1] Other factors included in the multivariate regression: Age category (18-34, 35-44, 45-64, 65+), race, presence of benign polyps, presence of diverticulisis/diverticulosis, smoker, concomitant hernia procedures, payor, provider bed size, provider region, year}

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88288

Program Number: P240

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster