Prior abdominal surgery characteristics predict adhesion phenotype and adhesiolysis in robotic colorectal cancer resection while preserving short-term outcomes.

Abstract

Background: Prior abdominal surgery (PAS) is common in patients undergoing robotic colorectal cancer (CRC) resection. Most studies have evaluated PAS as a binary exposure, leaving unclear which specific PAS characteristics are associated with technically relevant adhesions, adhesiolysis, and operative efficiency in robotic surgery.

Methods: This retrospective cohort study included 746 consecutive patients who underwent robotic CRC resection at a single institution between January 2018 and December 2025; 200 patients (26.8%) had a history of PAS. Among patients with PAS, associations between detailed PAS characteristics and intraoperative adhesion phenotype or adhesiolysis were assessed using multivariable regression analyses. Short-term outcomes between PAS and non-PAS patients were compared after 1:1 propensity score matching using age, sex, body mass index, American Society of Anesthesiologists physical status, preoperative treatment, primary tumor site, and clinical T stage.

Results: In the PAS cohort, adhesions were observed in 46.0 and 36.0% required adhesiolysis. Cancer-related PAS (adjusted odds ratio [aOR] 3.78, 95% confidence interval [CI] 1.36-11.4; p = 0.01) and prior open surgery (aOR 6.06, 95% CI 2.47-16.9; p < 0.01) independently predicted abdominal wall adhesions. Among adhesion-positive PAS patients, middle (aOR 15.2, 95% CI 1.34-172.9; p = 0.02) and lower abdominal PAS (aOR 12.2, 95% CI 3.05-48.9; p < 0.01) independently predicted adhesiolysis. After matching, operative time, console time, blood loss, conversion, and severe complications were comparable between groups. Mean differences were small for operative time (16.2 min, 95% CI -8.5 to 40.9), console time (10.6 min, 95% CI -7.6 to 28.8), and blood loss (12.9 mL, 95% CI -7.4 to 33.2).

Conclusions: Specific PAS characteristics, rather than PAS presence alone, were associated with technically relevant adhesions and adhesiolysis in robotic CRC resection. Despite increased technical burden, short-term outcomes remained comparable, supporting a more individualized interpretation of prior surgical history in robotic colorectal surgery.