ONCOmmunity

Comparison of Robotic, Laparoscopic, and Open Resections of Nonmetastatic Colon Cancer.

By: Jonathan B Yuval, Hannah M Thompson, Floris S Verheij, Megan Fiasconaro, Sujata Patil, Maria Widmar, Iris H Wei, Emmanouil P Pappou, J Joshua Smith, Garrett M Nash, Martin R Weiser, Philip B Paty, Julio Garcia-Aguilar

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
2023-1-17; doi: 10.1097/DCR.0000000000002637

Abstract

Background

Laparoscopic resection for colon cancer has not been associated with improvements in oncological outcomes in comparison to open resection. Robotic resections are associated with increased lymph node yield and radicality of mesenteric resection in patients with right-sided tumors. It is unclear whether lymph node yield is higher in robotic resections in other parts of the colon and whether higher lymph node yield is associated with improved survival.

Objective

To compare survival rates between robotic, laparoscopic, and open resections in a large cohort of patients with nonmetastatic colon cancer.

Design

This is a retrospective observational study.

Setting

This study was conducted at a single comprehensive cancer center.

Patients

Patients who underwent resection of nonmetastatic primary colon cancer between January 2006 and December 2018.

Main

Univariable and multivariable models were used to identify predictors of disease-free and overall survival. Lymph node yield and perioperative outcomes were compared between operative approaches.

Results

There were 2398 patients who met the inclusion criteria: 699 (29%) underwent open, 824 (34%) underwent laparoscopic, and 875 (36%) underwent robotic resection. Median follow-up was 3.8 years (45.4 months). Robotic surgery was associated with higher lymph node yield and radicality of mesenteric resection. On multivariable analysis, surgical approach was not associated with a difference in disease-free or overall survival. Minimally invasive colectomy was associated with fewer complications and shorter length of stay in comparison to open surgery. In a direct comparison between the two minimally invasive approaches, robotic colectomy was associated with fewer complications, shorter length of stay and lower conversion rate than laparoscopy.

Limitations

This was a single-center retrospective study.

Conclusions

Our data indicate that the three surgical approaches are similarly effective in treating primary resectable colon cancer and that differences in outcomes are seen primarily in the early postoperative period. See Video Abstract at http://links.lww.com/DCR/C115.