Katelin A Mirkin1, Audrey S Kulaylat1, Christopher S Hollenbeak1,2, Evangelos Messaris3. 1. Department of Surgery, Division of Colon & Rectal Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, H137, Hershey, PA, 17033-0850, USA. 2. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA. 3. Department of Surgery, Division of Colon & Rectal Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, H137, Hershey, PA, 17033-0850, USA. emessaris@pennstatehealth.psu.edu.
Abstract
BACKGROUND: While short-term data suggest that robotic resections are safe for oncologic operations, long-term outcomes remain uncertain. This study evaluates the impact of robotic and laparoscopic approaches on oncologic and survival outcomes in partial and total colectomies for colon cancer. METHODS: The US National Cancer Database (2010-2012) was reviewed for patients with stage I-III adenocarcinoma of the colon, who underwent robotic and laparoscopic partial or total colectomies. Lymph node retrieval, surgical margins, and survival were compared between surgical approaches with linear and logistic regressions. Propensity score matching was then used to create comparable laparoscopic and robotic cohorts and compare survivor functions. RESULTS: Of 15,112 patients, 5.1% underwent robotic approaches (n = 765, conversion rate 10.6%), and 94.9% laparoscopic (n = 14,347, conversion rate 15.1%). Robotic approach was associated with Hispanic race (p = 0.009), private insurance (p = 0.001), and earlier stage (p = 0.028). There was no difference in number of lymph nodes retrieved (p = 0.6200) or negative surgical margins (p = 0.6700). In multivariate analysis, robotic approaches were associated with an improved hazard of mortality (HR 0.79, p = 0.027). Linear regression found no difference in lymph node retrieval (- 0.39, p = 0.285). Logistic regression found no difference in rates of positive margins (OR 1.09, p = 0.649). After propensity score matching, robotic approaches were associated with improved survival in stage II (5YS 66.9% vs. 56.8%, p = 0.0189) and III disease (5YS 78.6% vs. 64.9%, p = 0.0241). CONCLUSION: Robotic approaches to partial and total colectomies for stage I-III colon cancer offer comparable oncologic outcomes as laparoscopic approaches. Relative to laparoscopic approaches, robotic approaches appear to offer improved long-term survival.
BACKGROUND: While short-term data suggest that robotic resections are safe for oncologic operations, long-term outcomes remain uncertain. This study evaluates the impact of robotic and laparoscopic approaches on oncologic and survival outcomes in partial and total colectomies for colon cancer. METHODS: The US National Cancer Database (2010-2012) was reviewed for patients with stage I-III adenocarcinoma of the colon, who underwent robotic and laparoscopic partial or total colectomies. Lymph node retrieval, surgical margins, and survival were compared between surgical approaches with linear and logistic regressions. Propensity score matching was then used to create comparable laparoscopic and robotic cohorts and compare survivor functions. RESULTS: Of 15,112 patients, 5.1% underwent robotic approaches (n = 765, conversion rate 10.6%), and 94.9% laparoscopic (n = 14,347, conversion rate 15.1%). Robotic approach was associated with Hispanic race (p = 0.009), private insurance (p = 0.001), and earlier stage (p = 0.028). There was no difference in number of lymph nodes retrieved (p = 0.6200) or negative surgical margins (p = 0.6700). In multivariate analysis, robotic approaches were associated with an improved hazard of mortality (HR 0.79, p = 0.027). Linear regression found no difference in lymph node retrieval (- 0.39, p = 0.285). Logistic regression found no difference in rates of positive margins (OR 1.09, p = 0.649). After propensity score matching, robotic approaches were associated with improved survival in stage II (5YS 66.9% vs. 56.8%, p = 0.0189) and III disease (5YS 78.6% vs. 64.9%, p = 0.0241). CONCLUSION: Robotic approaches to partial and total colectomies for stage I-III colon cancer offer comparable oncologic outcomes as laparoscopic approaches. Relative to laparoscopic approaches, robotic approaches appear to offer improved long-term survival.
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245