Colorectal cancer is one of the most common types of cancer with many patients undergoing colectomies – the surgical removal of part of the large intestine. The utilization of robotic surgery for these procedures is increasingly favored, offering surgeons enhanced 3D visualization, a steady camera, better dexterity, and instrument control, along with reduced fatigue and hand tremors. Yet, concrete real-world evidence demonstrating its superiority over laparoscopic methods has been scarce. Now, a new study has demonstrated that robotic surgery delivers better outcomes for many patients undergoing colectomies for colon cancer compared to laparoscopic procedures.

Researchers from UT Southwestern Medical Center (Dallas, TX, USA) discovered that patients who underwent robotic surgery typically experienced shorter hospital stays and lower complication rates in a vast majority of colectomy cases. Additionally, these patients had a greater number of lymph nodes removed, leading to a more precise determination of cancer staging, along with fewer transitions to open surgery due to anatomical challenges and reduced instances of postoperative ileus – a condition where the intestine fails to contract properly, risking a life-threatening blockage. While both laparoscopic and robotic surgeries are minimally invasive, using small incisions and a camera, they differ significantly. In laparoscopy, surgeons manually control the tools and use a thin, telescopic 2D camera called a laparoscope. In contrast, robotic surgery involves a control console to direct robotic arms equipped with surgical tools, offering a superior 3D view, enhanced precision, and range of motion, and negating any hand tremors.

For this comparative study, UTSW researchers examined data from the American College of Surgeons National Surgical Quality Improvement Program database spanning 2015-2020, including 53,209 colectomy cases from the U.S. The study defined a textbook outcome as the absence of 30-day complications, readmission, mortality, and a postoperative stay of fewer than five days. Results revealed that 71% of robotic procedures for right colectomies achieved textbook outcomes compared to 64% for laparoscopic ones. Similar trends were observed for left colectomies, at 75% versus 68%. However, for low anterior resections involving the rectum, laparoscopy performed slightly better, with robotic surgery associated with higher rates of postoperative ileus, hospital readmission, and major morbidity, though with comparable rates of textbook outcomes (68% versus 67%). The researchers speculate that these minor advantages of laparoscopy might be due to the increased complexity of rectal resections and surgeons’ more extensive experience with the laparoscopic approach.

“The growth in robotic surgery and the alarming increase in colorectal cancer in younger adults are two of the most significant trends we have seen in recent years, both of which highlight the importance of optimizing surgical treatment strategies,” said study leader Patricio M. Polanco, M.D. “These findings are critical because they give us a deeper understanding of the benefits and drawbacks of robotic surgery and can help patients and their surgical teams make informed decisions regarding their treatment.” 

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