Single-port robotic and conventional multiport laparoscopic colectomy for colon cancer: an overlap-weighted comparison of perioperative and oncologic outcomes.

Abstract

Comparative evidence for single-port colectomy with robotic system remains limited, particularly for long-term cancer control. We compared perioperative recovery and oncologic outcomes following single-port robotic surgery (SPRS) and conventional multiport laparoscopic surgery (CMLS) in colon cancer. This retrospective study screened 710 patients treated surgically between March 2019 and February 2025. The analytic cohort was balanced with propensity score overlap weighting (PSOW), after which operative, postoperative, pathologic, and survival data were compared. The analysis included 472 patients (142 SPRS and 330 CMLS). PSOW balanced the four covariates specified in the propensity model. SPRS had a longer mean operative time (255.0 vs. 197.5 min, p < 0.001), but no patient required open conversion (0.0% vs. 3.1%, p = 0.011). Compared with CMLS, SPRS was followed by earlier passage of flatus (2.4 vs. 3.4 days), earlier tolerance of a soft diet (3.3 vs. 4.8 days), and a shorter postoperative stay (7.5 vs. 8.5 days) (all p ≤ 0.001). Pain scores through postoperative day 5 were lower after SPRS (all p < 0.001), whereas complication rates and pathologic measures were similar. Three-year relapse-free survival (RFS) was 95.2% after SPRS and 95.1% after CMLS (p = 0.835); the corresponding overall survival (OS) were 97.2% and 94.8% (p = 0.104). Surgical modality was not an independent predictor of RFS or OS. Within the available follow-up, SPRS provided oncologic results comparable to CMLS while being associated with less postoperative pain and enhanced recovery. These data support SPRS as a feasible approach for selected patients with colon cancer.