[Transition phase to robot-assisted surgery for colorectal cancer: a comparative consecutive cohort study].

Abstract

Background: Colorectal cancer is increasingly being treated with a minimally invasive approach and, more recently, also robot-assisted surgery.

Methods: This controlled cohort study of colorectal cancer surgery compares the results during the transition period from conventional laparoscopy (2015-2017) to robot-assisted surgery (2018-2022). The parameters examined included postoperative complications according to the Clavien-Dindo classification, the TNM classification, the number of resected lymph nodes, and the Textbook Oncologic Outcome (TOO).

Results: In the robotic group there were more patients with ASA classification grades 3-4 (p = 0.016), in the laparoscopic group there were more left-sided and rectal tumors and in the robotic group there were more tumors of the transverse colon and right-sided colon (p < 0.001). In the laparoscopic group more patients required a reoperation (R 5% vs. L 19%; p = 0.007), there were more complications in general (R 22% vs. L 40%) and more severe complications in particular (CDC grade ≥ III, R 8% vs. L 25%; p = 0.023). Anastomotic leaks occurred more often in the laparoscopic group (R 5% vs. L 17%, p = 0.032). No significant differences were found in either the 2‑year survival (OS) or recurrence-free survival (RFS, OS: R 97% vs. L 98%, p = 0.455. RFS: R 98% vs. L 92%, p = 0.232). In the laparoscopy group, significantly more tumor recurrences occurred over the course of 4 years (R 1% vs. L 14%; p = 0.009). There were more patients with TOO in the robot-assisted (89.53%) than in the laparoscopic groups (53.79%).

Conclusion: The transition phase from laparoscopy to robotics was safe: complications were reduced and TOOs increased, lymph node resection and 2‑year survival were comparable. Robotic-assisted oncological surgery can be offered in a high-quality manner at a central hospital and makes an important contribution to the quality of patient care.