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Background <p>Colorectal cancer is increasingly being treated with a minimally invasive approach and, more recently, also robot-assisted surgery.</p> Methods <p>This controlled cohort study of colorectal cancer surgery compares the results during the transition period from conventional laparoscopy (2015–2017) to robot-assisted surgery (2018–2022). The parameters examined included postoperative complications according to the Clavien-Dindo classification, the TNM classification, the number of resected lymph nodes, and the Textbook Oncologic Outcome (TOO).</p> Results <p>In the robotic group there were more patients with ASA classification grades&#xa0;3–4 (<i>p</i> = 0.016), in the laparoscopic group there were more left-sided and rectal tumors and in the robotic group there were more tumors of the transverse colon and right-sided colon (<i>p</i> &lt; 0.001). In the laparoscopic group more patients required a reoperation (R&#xa0;5% vs. L&#xa0;19%; <i>p</i> = 0.007), there were more complications in general (R&#xa0;22% vs. L&#xa0;40%) and more severe complications in particular (CDC grade ≥ III, R&#xa0;8% vs. L&#xa0;25%; <i>p</i> = 0.023). Anastomotic leaks occurred more often in the laparoscopic group (R&#xa0;5% vs. L&#xa0;17%, <i>p</i> = 0.032). No significant differences were found in either the 2‑year survival (OS) or recurrence-free survival (RFS, OS: R&#xa0;97% vs. L&#xa0;98%, <i>p</i> = 0.455. RFS: R&#xa0;98% vs. L&#xa0;92%, <i>p</i> = 0.232). In the laparoscopy group, significantly more tumor recurrences occurred over the course of 4&#xa0;years (R&#xa0;1% vs. L&#xa0;14%; <i>p</i> = 0.009). There were more patients with TOO in the robot-assisted (89.53%) than in the laparoscopic groups (53.79%).</p> Conclusion <p>The transition phase from laparoscopy to robotics was safe: complications were reduced and TOOs increased, lymph node resection and 2‑year survival were comparable. Robotic-assisted oncological surgery can be offered in a&#xa0;high-quality manner at a&#xa0;central hospital and makes an important contribution to the quality of patient care.</p>

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Übergangsphase zur roboterassistierten Chirurgie beim kolorektalen Karzinom: eine vergleichende konsekutive Kohortenstudie

  • 期刊论文

  • 发表日期：

    2025年6月5日

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  • U. A. Dietz,
  • M. Kalisvaart,
  • S. Maksimovic,
  • R. Frey,
  • M. Ramser,
  • B. M. Erhart,
  • U. Pfefferkorn

摘要

Background

Colorectal cancer is increasingly being treated with a minimally invasive approach and, more recently, also robot-assisted surgery.

Methods

This controlled cohort study of colorectal cancer surgery compares the results during the transition period from conventional laparoscopy (2015–2017) to robot-assisted surgery (2018–2022). The parameters examined included postoperative complications according to the Clavien-Dindo classification, the TNM classification, the number of resected lymph nodes, and the Textbook Oncologic Outcome (TOO).

Results

In the robotic group there were more patients with ASA classification grades 3–4 (p = 0.016), in the laparoscopic group there were more left-sided and rectal tumors and in the robotic group there were more tumors of the transverse colon and right-sided colon (p < 0.001). In the laparoscopic group more patients required a reoperation (R 5% vs. L 19%; p = 0.007), there were more complications in general (R 22% vs. L 40%) and more severe complications in particular (CDC grade ≥ III, R 8% vs. L 25%; p = 0.023). Anastomotic leaks occurred more often in the laparoscopic group (R 5% vs. L 17%, p = 0.032). No significant differences were found in either the 2‑year survival (OS) or recurrence-free survival (RFS, OS: R 97% vs. L 98%, p = 0.455. RFS: R 98% vs. L 92%, p = 0.232). In the laparoscopy group, significantly more tumor recurrences occurred over the course of 4 years (R 1% vs. L 14%; p = 0.009). There were more patients with TOO in the robot-assisted (89.53%) than in the laparoscopic groups (53.79%).

Conclusion

The transition phase from laparoscopy to robotics was safe: complications were reduced and TOOs increased, lymph node resection and 2‑year survival were comparable. Robotic-assisted oncological surgery can be offered in a high-quality manner at a central hospital and makes an important contribution to the quality of patient care.