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

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

World J Gastrointest Surg. 2021 Dec 27;13(12):1660-1672. doi: 10.4240/wjgs.v13.i12.1660.

Authors

Zhi-Xiang Huang¹, Zhen Zhou², Hao-Ran Shi², Tai-Yuan Li¹, Shan-Ping Ye³

Affiliations

¹ General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
² The First Clinical Medical College, Jiangxi Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China.
³ General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China. yeshanping123@sina.com.

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