Improved Surgical Efficacy, Morbidity with Robot-Assisted Colon Surgery

In a recent meta-analysis, researchers found that robot-assisted colon surgery (RCS) showed advantages in colonic cancer regarding surgical efficacy and morbidity, when compared to laparoscopic colon surgery (LCS). This is true even though there was a predominant inclusion of non-randomized clinical trials (RCT) with serious risk of bias assessment and a very low level of evidence.

Though there has been rapid advancement of minimally invasive surgery within the last 20 years, there is still a lack of evidence when it comes to RCS for cancer. The benefits of RCS compared to LCS have yet to be thoroughly examined in RCT.

Researchers used Embase, MEDLINE, and Cochrane Library for RCT and observational studies between January 1, 2005 and October 2, 2020, excluding any non-original literature. Primary endpoints were anastomotic leakage rate, conversation to open surgery, operative time, and length of hospital stay, with secondary endpoints of surgical efficacy and postoperative morbidity. The authors wrote, “We evaluated risk of bias using RoB2 and ROBINS-I quality assessment tools. We performed a pooled analysis of primary and secondary endpoints. Heterogeneity was assessed by I2, and possible causes were explored by sensitivity- and meta-regression analyses. Publication bias was evaluated by Funnel plots and Eggers linear regression test. The level of evidence was assessed by GRADE.”

The researchers included 20 studies, with 13,799 patients enrolled, in the meta-analysis. Of these patients, 1740 experience RCS (12.6%) and 12,059 (87.4%) experience LCS. According to the authors, RCS was found to be “superior regarding: anastomotic leakage (odds ratio (OR) = 0.54, 95% CI [0.32, 0.94]), conversion (OR = 0.31, 95% CI [0.23, 0.41]), overall complication rate (OR = 0.85, 95% CI [0.73, 1.00]) and time to regular diet (MD =  − 0.29, 95% CI [− 0.56, 0.02]).” However, LCS was found to have “a shortened operative time compared to RCS (MD = 42.99, 95% CI [28.37, 57.60]).”

According to GRADE assessment, the quality of evidence was very low, mainly due to serious risk of bias and/or inconsistency.

This meta-analysis “indicates that RCS for colon cancer is superior to LCS in several intra- and postoperative outcomes with regard to a very low level of evidence and serious risk of bias.” Due a lack of studies comparing exclusively left-sided colon surgery, the authors added that their result should “only be applied to right-sided resections.” There is a need for prospective randomized studies investigating intra- and extracorporeal techniques in RCS.

—Allison Casey

Reference:
Cuk P, Kjær MD, Mogensen, CB, et al. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc. Published online November 1, 2022. DOI: 10.1007/s00464-021-08782-7