Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1660-1672
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1660
Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center
Zhi-Xiang Huang, Zhen Zhou, Hao-Ran Shi, Tai-Yuan Li, Shan-Ping Ye
Zhi-Xiang Huang, Tai-Yuan Li, Shan-Ping Ye, General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Zhi-Xiang Huang, Zhen Zhou, Hao-Ran Shi, The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Huang ZX and Ye SP wrote and revised the paper; Ye SP, Li TY designed and proofread the manuscript; Huang ZX, Ye SP, Zhou Z and Shi HR collected the data and conducted the analysis of pooled data.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shan-Ping Ye, MD, Doctor, General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. yeshanping123@sina.com
Received: May 21, 2021
Peer-review started: May 21, 2021
First decision: June 22, 2021
Revised: July 16, 2021
Accepted: December 2, 2021
Article in press: December 2, 2021
Published online: December 27, 2021
Processing time: 216 Days and 13.3 Hours
Abstract
BACKGROUND

As a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient.

AIM

To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.

METHODS

In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated.

RESULTS

Among 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection (P < 0.001) and level III American Society of Anesthesiologists (ASA) score (P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection (P < 0.001) and comorbidities (P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were independent risk factors. Multiple organ resection (P < 0.001) and level III ASA score (P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery.

CONCLUSION

Multiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.

Keywords: Colorectal neoplasms; Surgery; Robot; Complication; Postoperative; Classification; Retrospective studies

Core Tip: This retrospective study of 1040 cases was performed to analyze the incidence and risk factors for postoperative complications after robotic colorectal cancer surgery. The postoperative complications were defined into four types: Overall, severe, local, and systemic complications, and their rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Their independent risk factors were as follows: (1) Overall complications: Multiple organ resection and a level III American Society of Anesthesiologists (ASA) score; (2) Severe complications: Multiple organ resection and comorbidities; (3) Local complications: Multiple organ resection and multiple bowel resection; and (4) Systemic complications: Multiple organ resection and a level III ASA score.