Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1660
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
As a common malignant tumor of the digestive tract, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery for the treatment of CRC is one of the future trends in surgical treatment. With several technical advantages of 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, the da Vinci surgical system is better than laparoscope and these technical benefits lead to better surgical outcomes and faster recovery. However, it is impossible to accurately explain which factors will affect the complications of robotic surgery because of the lack of high-quality randomized controlled studies.
To provide new ideas and directions for reducing complications, through the analysis of incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.
To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.
In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were classified as minor complications, severe complications, local complications, and systemic complications, and their possible risk factors were assessed. Variables that were statistically significant (P < 0.05) in univariate analysis were included in multivariate analysis. To identify independent risk factors for postoperative complications, the logistic regression model was used in multivariate analysis.
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 a 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 (Clavien-Dindo grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were identified as independent risk factors. Multiple organ resection (P < 0.001) and a level III ASA score (P = 0.007) were identified as 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.
The present study demonstrated, in detail, the postoperative complications of robotic procedure to treating patients with CRC, and identified several factors that were independent and significant predictors of the complication rate after robotic CRC surgery. Among them, multiple organ resection was the greatest independent risk factor for complications.
The development of robotic surgery is unstoppable, and the application of robotic surgery to CRC will become more and more widespread. Therefore, research on the risk factors of complications is essential. It will not only provide the possibility to reduce complications in the future but also promote the development of robotic surgery.