Title : Comparing outcomes for open, laparoscopic and robotic colorectal resections; a single center retrospective cohort study
Abstract:
Introduction: Recent years have seen advances in Minimally Invasive Surgery (MIS) to colorectal surgery, including Laparoscopic and Robotic. Apart from shorter length of stay for Robotic assisted surgeries, most studies do not demonstrate a clear advantage of one MIS technique over the other. We evaluated patient outcomes for these surgical modalities and present our findings.
Objective: We studied a case series of patients undergoing Open, Laparoscopic, and Robotic colorectal surgery in the past year, to study the safety and effectiveness between these techniques. Methods: A list of patients who underwent elective colorectal resections by either Open, Laparoscopic or Robotic approach, between 1/1/2021 and 31/12/2021 was obtained. Emergency colorectal procedures were not included. Measured outcomes were: conversion to open surgery, anastomotic leak rate, return to theatre, length of hospital stay, and mortality within 30 and 90 days of surgery.
Results: A total of 174 colorectal resections were performed in 2021 (104 Laparoscopic, 49 Open, and 21 Robotic). Conversion rates for Laparoscopic and Robotic surgery were 20% and 0%, respectively. Overall, the indication for resection included 151/174 (87%) malignant cases. A total of 156 resections ended up with a primary anastomosis, with 16 leaks (8 Open, 8 Laparoscopic, 0 Robotic) with 3 (2 Open, 1 Laparoscopic) requiring a return to theatre. Median length of stay was 8, 6, and 4 days for Open, Laparoscopic and Robotic surgery, respectively. 30 day mortality was 1/174 (1 Laparoscopic) while 90 day mortality was 3/174 (1 Laparoscopic, 2 Open).
Conclusion: Our experience shows that Robotic surgery confers better overall outcomes when compared to Open and Laparoscopic surgery for elective colorectal resections, with much lower rates of complications, median length of hospital stays and overall mortality.
Keywords: Colorectal surgery, Robotic surgery, Robot assisted surgery, Minimally Invasive surgery (MIS)
