Abstract
BackgroundThe application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with locally advanced rectal adenocarcinoma undergoing preoperative concurrent chemoradiotherapy (CCRT).MethodsIn total, 203 patients with locally advanced rectal adenocarcinoma who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 matches was used to match PAS patients with non-PAS.ResultsOf the 203 enrolled patients, 35 were PAS patients and 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time (165 min (PAS) vs. 175 min (non-PAS), P = 0.4542) and median operation time (275 min (PAS) vs. 290 min (non-PAS), P = 0.5943) after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.ConclusionThe current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with locally advanced rectal adenocarcinoma undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.
Highlights
The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial
Before propensity score matching (PSM), the median console time was shorter in PAS patients than in non-PAS patients (167.5 vs. 187.5 min, P = 0.0394), but no such between-group difference in median operation times (275 min (PAS) vs. 300 min, P = 0.0748)
With the PSM, the comparison between the groups was adjusted for confounding variables, and this analysis showed that there is no difference between the groups
Summary
The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with locally advanced rectal adenocarcinoma undergoing preoperative concurrent chemoradiotherapy (CCRT). According to the last issue of GLOBOCAN (2018), colorectal cancer (CRC) is the third most common cancer and the third leading cause of cancer-related deaths in the world [1]. In Taiwan, CRC is the most common cancer type and has been the third leading cause of cancer-related deaths since 1996. In 2019, 6436 people in Taiwan died of CRC, with the mortality rate being 27.3 and 20.6 per 100,000 individuals in 2019 and 2009, respectively [3]
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