Comparison of Surgical Outcomes between Robotic and Laparoscopic Colorectal Surgery: a single centre experience.

San Pio X Hospital, Milan – Italy

Jacques Mégevand, MD

Colorectal Surgery Experience

374 pts January 2010 May 2015

Open surgery

125 pts 249 pts (66.5%)

Mini – invasive approach

Colorectal Surgery Experience

249 pts treated for benign and malignant disease

January 2010 May 2015

131 ptsLaparoscopic technique

118 ptsRobotic technique

May 2012 May 2015

Laparoscopic Group

Women 64 pts (48.7 %)Men 67 pts (51.3 %)

Mean Age 65 yy (range 37-91 yy)Screening 28/131 (21.3%)

BMI 25 (range 18-40)

ASA 1 20ASA 2 89ASA 3 22

131 pts

Laparoscopic Group

131 pts

113 pts

Malignacy (86%)

18 pts

Benign disease (14%)- Adenocarcinoma 92- Polyps w/ Adk 19- Neuroendocrin tumor 1- GIST 1- Diverticular disease 18

Total intracorporeal anastomosis: 64 pts (48.8%)

Extracorporeal anastomosis: 62 pts (47.2%)

Colostomy: 5 pts (4%)

Laparoscopic Group: procedures

- Right colectomies 52- Left colectomies 47- Subtotal colectomy 2- Low anterior resections 25- Abdominoperineal resections 5

Totally laparoscopic

Mean total operative time (TOT)

185 minutes (range 120-540 minutes)

Laparoscopic Group: Operative time

Mean total operative time (TOT)

178 minutes (range 85-435 minutes)

Laparoscopic assisted

Overall operative time

191 minutes (range 85-540 minutes)

Robotic Group

118 pts102 pts

Malignancy (86.4%)

16 pts

Benign disease (13.6%)

- Adenocarcinoma 93- Polyps w/ Adk 9- Diverticular disease 16

Robotic Group

Women 59 pts (50 %)Men 59 pts (50 %)

Mean Age 69 yy (range 38-92 yy)Screening 22/118 (18.6%)

BMI 24 (range 17-34)

ASA 1 14ASA 2 88ASA 3 16

118 pts

- Right colectomies 43- Left colectomies 43- Low anterior resections 21- Segmentary colectomy 5- Abdominoperineal resections 6

Robotic Group: procedures

Total intracorporeal anastomosis: 102 pts (86.4%)

Extracorporeal anastomosis: 10 pts (8.5%)

Colostomy: 6 pts (5.1%)

Operative TimeMean total operative time (TOT)

215 minutes (range 120-420* minutes)

Mean robotic time (RT)

145 minutes (range 45-335 minutes)

Mean docking time: (including trocars and patients positioning, lysis of adhesions and docking of patient cart)

19.0 minutes (range 9 - 60 minutes)

Robotic Group

* 420 min due to a left colectomy with bladder resection and ureteral stent placement

Laparoscopic Group

Conversion rate to open procedure

0% (0/118)

Robotic Group

6.9 % (9/131)

Clinical outcome

Totally laparoscopic

Laparoscopic assisted Robotic group

Fast track regimen 84 % (53 pts) 61.6 % (37 pts) 94 % (111 pts)

Oral intake 1 day (1-6) 2 dd (1-8) 1 day (1-2)*

First flatus 2 dd (1-4) 2 dd (1-7) 1 day (0-3)*

Stool discharge 4 dd (1-9) 5 dd (1-14) 3.5 dd (0-12)*

Mean Hospital stay 9 dd (5-24) 11 dd (4-58) 6 dd (3-38)*

* Statistically significant

Oncologic outcomes

Laparoscopic Group Robotic Group

Lymph nodes (mean n°) 23 (range 1-124) 18 (range 1-48)

Circumferential margin involvement 0 pts 0 pts

Distal margin (for rectal cancer) 2 cm (range 1-15) 3 (range 1-9)

The difference between the two groups not statistically significant

Complications

Complication Totally laparoscopic

Laparoscopic assisted

Laparoscopic group Robotic group

Anastomotic leakage 9.3 % (6/64) 12.9 % (8/62) 10.6 % (14/131) 2.5 % (3/118)

Anastomotic bleeding 12.5 % (8/64) 3.2 % (2/62) 7.6 % (10/131) 1.7 % (2/118)

Delays in stool canalization 4.7 % (3/64) 3.2 % (2/62) 4.0 % (5/131) 2.5 % (3/118)

Wound Infection 7.8 % (5/64) 1.6 % (1/62) 4.6 % (6/131) 0.8 % (1/118)

Hemesis 4.7 % (3/64) 9.7 % (6/62) 6.9 % (9/131) 1.7 % (2/118)

Duodenal ulcer perforation - 3.2 % (2/62) 1.5 % (2/131) -

Pneumonia 1.5 % (1/64) 1.6 % (1/62) 1.5 % (2/131) -

Postoperative occlusion - 3.2 % (2/62) 1.5 % (2/131) 1.7 % (2/118)

Ileal perforation - 1.6 % (1/62) 0.8 % (1/131) 0.8 % (1/118)

Hemiparesis - 1.6 % (1/62) 0.8 % (1/131) -

Laparoscopic Group

Reoperation rate for complications

Robotic Group

4.2 % (5/118)

8.4 % (11/131)

Anastomotic leak rate and treatment

10.6 % (14/131)

Surgical treatment42.8 % (6/14)

Conservative treatment57.2 % (8/14)

Totally laparoscopic

42.8 % (6/14)

Laparoscopic assisted

57.2 % (8/14)

Laparoscopic Group2.5 % (3/118)

Surgical treatment

Robotic Group

Anastomotic bleeding rate and treatment

7.6 % (10/131)

Conservative treatment

20 % (2/10)

Endoscopic treatment

80 % (8/10)

Surgical treatment

25 % (2/8)

Laparoscopic Group

2.5 % (3/118)

Conservative treatment

Robotic Group

Conclusion

Robotic Colorectal Surgery

Technique feasible and safe

Single docking for all colectomies (right, left, LAR

and APR)

Easier to perform TME and intracorporeal anastomosis

Conclusion

Robotic Colorectal Surgery

Clinical and surgical outcomes are better (anastomotic

leakage and bleeding, conversion rate and hospital stay).

Short-term oncological outcomes are comparable.

Operating time is longer in the beginning of experience.

High costs (+ 28%)

Chief. Jacques Mégevand, MD 

Andrea Rusconi, MDMassimo Amboldi, MDLeonardo Lenisa, MD

Ettore Lillo, MDRoberto Grignani, MD

Jacopo Catto Ronchino, MDSimona Borin, MDAnna Pertusati, MD

Robotic Colorectal Surgery

Staff of General Surgey Dep.