Details

Autor(en) / Beteiligte

• Ingham, Abigail R.
• Kong, Chia Yew
• Wong, Tin-Ning
• McSorley, Stephen T.
• McMillan, Donald C.
• Nicholson, Gary A.
• Alani, Ahmed
• Mansouri, David
• Chong, David
• MacKay, Graham J.
• Roxburgh, Campbell S. D.

Titel

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

Ist Teil von

• Surgical endoscopy, 2024-05, Vol.38 (5), p.2577-2592

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2024

Quelle

2022 ECC(Springer)

Beschreibungen/Notizen

• 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.