Robotic surgery may lead to reduced postoperative inflammatory stress in colon cancer: a propensity score-matched analysis

Abstract

Purpose: Robot-assisted surgery is readily applied to every type of colorectal surgeries. However, studies showing the safety and feasibility of robotic surgery (RS) have dealt with rectal cancer more than colon cancer. This study aimed to investigate how technical advantages of RS can translate into actual clinical outcomes that represent postoperative systemic response.

Methods: This study retrospectively reviewed consecutive cases in a single tertiary medical center in Korea. Patients with primary colon cancer who underwent curative resection between 2006 and 2012 were included. Propensity score matching was done to adjust baseline patient characteristics (age, sex, body mass index, American Society of Anesthesiologists physical status, tumor profile, pathologic stage, operating surgeon, surgery extent) between open surgery (OS), laparoscopic surgery (LS), and RS groups.

Results: After propensity score matching, there were 66 patients in each group for analysis, and there was no significant differences in baseline patient characteristics. Maximal postoperative leukocyte count was lowest in the RS group and highest in the OS group (P=0.021). Similar results were observed for postoperative neutrophil count (P=0.024). Postoperative prognostic nutritional index was highest in the RS group and lowest in the OS group (P<0.001). The time taken to first flatus and soft diet resumption was longest in the OS group and shortest in the RS group (P=0.001 and P<0.001, respectively). Among all groups, other short-term postoperative outcomes such as hospital stay and complications did not show significant difference, and oncological survival results were similar.

Conclusion: Better postoperative inflammatory indices in the RS group may correlate with their faster recovery of bowel motility and diet resumption compared to LS and OS groups.

Keywords: Colonic neoplasms; Postoperative period; Robotic surgical procedures.

Fig. 1.

Flowchart of the patient selection by propensity score matching. IBD, inflammatory bowel disease; BMI, body mass index; ASA, American Society of Anesthesiologists; OS, open surgery; LS, laparoscopic surgery; RS, robotic surgery.

Fig. 2.

Differences in the numbers of days taken for first flatus and soft diet resumption, and hospital stay duration among the open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) groups. Values are presented as mean±standard deviation.

Fig. 3.

Postoperative leukocyte and neutrophil counts and calculated PNI among the open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) groups. PNI, prognostic nutritional index.

Fig. 4.

Kaplan-Meier analysis of the overall survival among the open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) groups.

Fig. 5.

Kaplan-Meier analysis of disease-free survival among the open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) groups.