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Background <p>Obesity is associated with increased post-operative complications in patients undergoing surgery for colon or rectal cancer. Robotic surgery is increasingly being utilized for obese patients. There is a paucity of research comparing robotic surgery with more traditional approaches across subgroups of patients with varied body mass indices (BMIs).</p> Methods <p>The National Surgical Quality Improvement Program (NSQIP) was used for this retrospective study. Patients who underwent open, laparoscopic or robotic surgery for colon or rectal cancer between 2016 and 2022 were included. Patients were stratified by BMI: underweight (&lt; 18.5&#xa0;kg/m<sup>2</sup>), healthy (18.5–24.9&#xa0;kg/m<sup>2</sup>), overweight (25.0–29.9&#xa0;kg/m<sup>2</sup>), class I (30.0–34.9&#xa0;kg/m<sup>2</sup>), class II (35.0–39.9&#xa0;kg/m<sup>2</sup>), and class III (≥ 40.0&#xa0;kg/m<sup>2</sup>) obesity. Propensity score-based inverse probability weighted multivariable regression was used to assess associations of surgical approach with textbook outcome (TO) and major morbidity within 30&#xa0;days of surgery in each subgroup.</p> Results <p>A total of 52,588 patients were included: 11,437 (21.7%) robotic, 13,302 (25.3%) open, and 27,849 (53.0%) laparoscopic. TO was achieved significantly more often after robotic and laparoscopic procedures compared to open procedures (74.5% and 72.9% vs. 47.8%, respectively; <i>p</i> &lt; 0.001). On regression analysis, robotic surgery was associated with higher achievement of TO across all BMI categories compared to open or laparoscopic surgery. Robotic and laparoscopic surgery were associated with reduced odds of major morbidity compared to open surgery across all BMI categories. Additional subgroup analysis for rectal cancer patients revealed robotic surgery was associated with higher likelihood of TO across all BMI categories. Major morbidity was similar across all surgical approaches for rectal cancer patients with class II and III obesity.</p> Conclusion <p>Robotic surgery is associated with higher likelihood of TO achievement and lower risk of major morbidity across all BMI subgroups. Across all surgical approaches, class II and III obese patients with rectal cancer have comparable rates of major morbidity.</p>

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Outcomes of robotic, laparoscopic, and open surgery across body mass index subgroups for colon and rectal cancer

  • 期刊论文

  • 发表日期：

    2025年7月18日

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  • Usama Waqar,
  • Manali Rupji,
  • Yuan Liu,
  • Abhineet Uppal,
  • Seth A. Rosen

摘要

Background

Obesity is associated with increased post-operative complications in patients undergoing surgery for colon or rectal cancer. Robotic surgery is increasingly being utilized for obese patients. There is a paucity of research comparing robotic surgery with more traditional approaches across subgroups of patients with varied body mass indices (BMIs).

Methods

The National Surgical Quality Improvement Program (NSQIP) was used for this retrospective study. Patients who underwent open, laparoscopic or robotic surgery for colon or rectal cancer between 2016 and 2022 were included. Patients were stratified by BMI: underweight (< 18.5 kg/m2), healthy (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2), and class III (≥ 40.0 kg/m2) obesity. Propensity score-based inverse probability weighted multivariable regression was used to assess associations of surgical approach with textbook outcome (TO) and major morbidity within 30 days of surgery in each subgroup.

Results

A total of 52,588 patients were included: 11,437 (21.7%) robotic, 13,302 (25.3%) open, and 27,849 (53.0%) laparoscopic. TO was achieved significantly more often after robotic and laparoscopic procedures compared to open procedures (74.5% and 72.9% vs. 47.8%, respectively; p < 0.001). On regression analysis, robotic surgery was associated with higher achievement of TO across all BMI categories compared to open or laparoscopic surgery. Robotic and laparoscopic surgery were associated with reduced odds of major morbidity compared to open surgery across all BMI categories. Additional subgroup analysis for rectal cancer patients revealed robotic surgery was associated with higher likelihood of TO across all BMI categories. Major morbidity was similar across all surgical approaches for rectal cancer patients with class II and III obesity.

Conclusion

Robotic surgery is associated with higher likelihood of TO achievement and lower risk of major morbidity across all BMI subgroups. Across all surgical approaches, class II and III obese patients with rectal cancer have comparable rates of major morbidity.