Robotic colectomy has been associated with comparable or improved short-term morbidity and mortality when compared to laparoscopic colectomy, including shorter length of stay. In this study, we sought to understand oncologic advantages for robotic as compared to laparoscopic colectomy in colon cancer. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant user files for all elective colon cancer cases from 1/2016 through 12/2021 performed with minimally invasive surgical techniques (robotic and laparoscopic). We calculated relative risks (RR) through Poisson Regression models and treatment effect coefficients by propensity-score match, after adjusting for age, BMI, ASA scores, mechanical and antibiotic bowel preparation, emergency surgery, race, gender, smoking status, hypertension and diabetes mellitus. Analyzed outcomes included rate of chemotherapy initiation within 90 days of surgery, number of harvested lymph nodes, any occurrence of intraoperative or postoperative blood transfusion, and the need for ostomy. During the study period, 44,745 patients underwent minimally invasive colectomy for colon cancer; 39,614 in the laparoscopic cohort and 7,831 in the robotic cohort. After adjusting for confounders, robotic colectomy was associated with a significant increase in the likelihood for initating chemotherapy within 90 days (RR 1.98, 95% CI {1.86-2.10}, p < 0.001). The robotic-treated patients had a significantly more lymph nodes harvested, a significant decrease in the need for intraperative or postoperative blood transfusion (RR 0.64, 95% CI {0.57-0.71}, p < 0.001) and a significant reduction in the need for ostomy formation (RR 0.26, 95% CI {0.22-0.30}, p < 0.001). As a retrospective and non-randomized study, residual bias and confouding variables are likely to exist. The study is also subject to coding incompleteness and inaccuracies. We also do not have additional context on potential factors that might influence time to chemotherapy. In addition, there is no information on surgeon or hospital volume, which can be associated with outcomes. Robotic colectomy for colon cancer was associated with significant improvement in the rate of chemotherapy initiation within 90 days, a significant reduction in need for blood transfusions, and a lower likelihood of receiving an ostomy when compared to laparoscopic colectomy procedures. The data reveal substantial short-term gains in oncologic outcomes for colon cancer performed with robotic techniques.

Keywords: Laparoscopic; Robotic; Colectomy; Colon cancer; Colorectal; Minimmaly invasive surgery.

© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

机器人结肠切除术与腹腔镜结肠切除术相比，在短期并发症和死亡率方面具有可比性或更佳的效果，包括住院时间更短。在这项研究中，我们旨在了解机器人结肠切除术相较于腹腔镜结肠切除术在治疗结直肠癌方面的肿瘤学优势。我们分析了美国外科医师学会全国外科质量改进计划（NSQIP）参与者用户文件中的所有选择性结直肠癌病例数据，这些病例从2016年1月到2021年12月采用微创手术技术（机器人和腹腔镜）进行治疗。通过泊松回归模型计算相对风险（RR），并通过倾向评分匹配来计算处理效应系数，在调整年龄、BMI、ASA评分、机械和抗生素肠道准备、急诊手术、种族、性别、吸烟状况、高血压和糖尿病等因素后得出结果。分析的指标包括术后90天内开始化疗的比例，淋巴结采集数量，术中或术后输血的发生率以及造口的需求。在研究期间，共有44,745名患者接受了微创结肠切除术治疗结直肠癌；其中39,614名采用腹腔镜手术，7,831名采用机器人手术。调整混杂因素后，机器人结肠切除术与术后90天内开始化疗的可能性显著增加相关（RR 1.98，95% CI {1.86-2.10}，p < 0.001）。接受机器人治疗的患者淋巴结采集数量更多，并且输血需求（RR 0.64，95% CI {0.57-0.71}，p < 0.001）和造口形成的需求（RR 0.26，95% CI {0.22-0.30}，p < 0.001）显著降低。由于本研究为回顾性和非随机对照设计，可能存在残余偏差和混杂变量影响结果。该研究还可能受到编码不完整和准确性问题的影响。此外，我们没有关于可能导致化疗开始时间差异的额外因素的信息。另外，也没有提供有关外科医生或医院手术量的数据，这些数据与治疗效果相关。对于结直肠癌患者而言，机器人结肠切除术相较于腹腔镜结肠切除术，在术后90天内开始化疗的比例、输血需求和造口形成的需求方面具有显著的改善。数据显示采用机器人技术进行结直肠癌手术在短期内肿瘤学结局有明显的优势。

关键词：腹腔镜；机器人；结肠切除术；结直肠癌；结肠直肠外科；微创手术。