Robotic Surgery in Colorectal Cancer

Dear Colleagues,

Many colorectal cancer patients have benefited from minimally invasive surgery. To a certain extent, the adoption and applicability of conventional laparoscopy have been curtailed by the technical limitations imposed by the equipment. Robotic surgery has been developed to address some of these issues. While early studies on robotic surgery in colorectal cancer focused on its feasibility and safety, more contemporary studies have sought to compare its outcomes with laparoscopy—in particular, its cost effectiveness.

We are pleased to invite you to contribute original research or review articles to this Special Issue, focusing on the use of robotic surgery in colorectal cancer and how recent data have helped us to distinguish it from conventional laparoscopy. Studies addressing the clinical outcomes, ergonomics, and costs are welcomed.

Dr. James Chi Yong Ngu
Guest Editor

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• robotic surgery
• colorectal cancer
• minimally invasive surgery
• therapeutic endoscopy
• laparoscopy

Title: Robotic-Assisted Colon Cancer Surgery: Faster Recovery and Fewer Complications Compared to Laparoscopy in retrospective propensity matching study
Authors: Chun-Yu Lin a,b*, Yi-Chun Liu a,c,d*, Chou-Chen Chen b,d , Ming-Cheng Chen b, e, Teng-Yi Chiu b, Yi-Lin Huang b, Shih-Wei Chiang b, Chang-Lin Lin b, Ying-Jing Chen b, Chen-Yen Lin b, Jin-Ching Lin a,c
Affiliation: a.Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan b.Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital,Taichung, Taiwan c.Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan d.Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan e.School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan f. Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan g. College of humanities and social sciences, Providence University, Taichung, Taiwan
Abstract: Background Colorectal cancer (CRC) is one of the most common cancers worldwide, ranking third in incidence and second in cancer-related deaths globally. In 2020, the global incidence of CRC was approximately 1.9 million new cases annually. Colon cancer accounts for around 60% of all CRC cases. Surgery is the optimal treatment for stage I-III colon cancer. Minimally invasive techniques, such as robotic-assisted surgery (RAS) and laparoscopic surgery (LSS), can reduce recovery time and minimize complications. The choice between these techniques for colon cancer resection often depends on the surgeon and the facilities available. This study analyzes perioperative outcomes between RAS and LSS in colon cancer resections. Material and Methods Between January 1, 2018, and February 29, 2023, we retrospectively collected data on colon cancer patients with clinical stage I-III who underwent elective colon resection via either robotic-assisted or laparoscopic surgery. Preoperative characteristics, intraoperative outcomes, and postoperative recovery indicators were gathered and compared between the two groups. The primary outcome was recovery time , while the secondary outcome was surgery-related complications. Data analysis was conducted from June 1 to August 15, 2024. Result A total of 179 robotic-assisted surgeries and 652 laparoscopic surgeries were analyzed. After propensity matching for gender, age, lesion site, and ASA score, there were 179 cases in the RAS group and 358 cases in the LSS group. RAS was associated with significantly longer operative times (mean: 284.4 ± 66.5 vs. 209.5 ± 85.2 minutes, p<0.001) but fewer conversions to open surgery (0.6% vs. 3.9%, p=0.026). Postoperative recovery was faster in the RAS group, with earlier initiation of drinking, eating, and bowel movements, and shorter hospital stays (5.8 ± 4.9 vs. 9.2 ± 6.2 days, p<0.001). A higher proportion of textbook outcomes was also noted. The diuretic phase occurred earlier in the RAS group (1.0 vs. 3.0 days, p=0.001), and postoperative pain scores were significantly lower in the RAS group (3.1 vs. 5.0, p=0.001). RAS was associated with lower rates of minor complications, including significantly fewer instances of ileus (8.4% vs. 21.5%, p<0.001) and chyle leakage (0% vs. 2.1%, p=0.049). There was a trend toward fewer cardiovascular events (0.0% vs. 2.2%, p=0.057), pneumonia (3.4% vs. 5.7%, p=0.255), and urinary tract infections (1.1% vs. 2.8%, p=0.353) in the RAS group. The risk of major complications was similar between the groups (4.5% vs. 5.3%, p=0.675), with identical anastomotic leakage rates (2.2% vs. 2.2%, p=1.000). However, the readmission rate was higher in the RAS group (10.6% vs. 6.1%, p=0.066), primarily due to minor complications (83.3%). Conclusions Robotic-assisted surgery for colon cancer demonstrates significant advantages in terms of faster recovery, less postoperative pain, and fewer minor complications compared to conventional laparoscopic surgery.