Similar Robotic and Laparoscopic Postoperative Outcomes in Morbid Obesity With CRC

There are no significant differences in postoperative complications between robotic and laparoscopic operation in patients with morbid obesity and colorectal cancer (CRC), according to study findings in the Journal of Gastroenterology and Hepatology.

Conventional laparoscopic CRC resection is effective in removing lesions, but has limited clinical application due to slow postoperative recovery and procedural trauma. Minimally invasive surgical procedures, such as robotic operation, are gaining popularity in recent years due to more favorable postoperative outcomes.

Researchers conducted a population-based, retrospective study to compare the postoperative outcomes of robotic and conventional laparoscopic CRC resection in patients with morbid obesity. Data from 2005 through 2018 were collected from the US Nationwide Inpatient Sample (NIS) database, the largest inpatient care database with data on 8 million hospital stays. All participants had morbid obesity (BMI ≥ 40 kg/m²), were diagnosed with CRC, and were admitted to the hospital to undergo robot-assisted or laparoscopic resection.

The study outcomes were the occurrence of major postoperative complications during hospitalization, prolonged length of stay (LOS) at the hospital (defined as LOS ≥75th percentile), and total costs of hospitalization. All diagnoses were made in accordance with the International Classification of Diseases (ICD), Ninth (ICD-9) and Tenth (ICD-10) Revision.

The researchers identified 4,087 patients with CRC who were aged at least 20 years. After exclusion, 1,296 patients remained in the analysis, with 648 patients in each study group. 

Study participants had a mean [SD] age of 62.3[19] years, 54.3% were women, and 74.1% were White. Among all study participants, 35.3% patients had at least 1 major postoperative complication. 

There were no significant differences between robotic and laparoscopic operation regarding risk for postoperative complications (adjusted odds ratio [aOR], 0.99; 95% CI, 0.80-1.22), prolonged LOS (aOR, 0.80; 95% CI, 0.63-1.01), death (aOR, 0.57; 95% CI, 0.11-3.10), or pneumonia (aOR, 1.13; 95% CI, 0.73, 1.77). 

However, patients who underwent robotic operation had greater total hospitalization costs, compared with those receiving laparoscopic operation (95% CI, 16.08-36.45).

In the stratified analysis for patients with tumors located in the colon, robotic operation was associated with a lower risk for prolonged LOS (aOR, 0.72; 95% CI, 0.54-0.95).

Study limitations include the inability to generalize results to other populations or locations, potential coding errors, the inability to account for intraoperative parameters, and the lack of follow-up data. 

“In patients with morbid obesity and CRC undergoing tumor resections, the risks of postoperative complication, death, or pneumonia are not significantly different between robotic and conventional laparoscopic surgery,” study authors noted. “Among patients with tumor located at the colon, robotic surgery has certain benefit over laparoscopic surgery in terms of significantly lower risk of prolonged LOS. However, robotic surgery is independently associated with higher total hospital cost than conventional laparoscopic surgery.”

This article originally appeared on Gastroenterology Advisor