Robotic-assisted surgery for left-sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study.

Autor: Ingham AR; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., Kong CY; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., Wong TN; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., McSorley ST; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., McMillan DC; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., Nicholson GA; Department of General Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK., Alani A; Department of General Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK., Mansouri D; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., Chong D; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., MacKay GJ; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK., Roxburgh CSD; Academic Unit of Surgery and School of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK. campbell.roxburgh@glasgow.ac.uk.; Lister Department of Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK. campbell.roxburgh@glasgow.ac.uk.; Academic Unit of Surgery, School of Cancer Sciences, Room 2.60, Level 2 New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK. campbell.roxburgh@glasgow.ac.uk.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 May; Vol. 38 (5), pp. 2577-2592. Date of Electronic Publication: 2024 Mar 18.
DOI: 10.1007/s00464-024-10749-3
Abstrakt: Introduction: There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS.
Methods: Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models.
Results: A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21-0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26-0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26-0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033).
Conclusions: The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.
(© 2024. The Author(s).)
Databáze: MEDLINE
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