Robotic and laparoscopic surgeries for colorectal cancer: learning curve and short-term outcomes

Abstract

Objective: comparative evaluation of perioperative clinicopathologic characteristics and short-term outcomes of robotic and laparoscopic surgeries for colorectal cancer (CRC), depending on the phases of the learning curve. Materials and methods. Patients who underwent robotic or laparoscopic surgeries were compared retrospectively (n = 77 and n = 123 respectively). Cumulative sum (CUSUM) was used to evaluate the learning curve. Results. Robotic operations were comparable with laparoscopic in the average blood loss and conversion rate, but differed in the longer duration (237.5 ± 74.9 min versus 213.5 ± 73.1 min, p = 0.024). The short-term outcomes and pathomorphological characteristics were not significantly different in both procedures. According to CUSUM, the learning curve of robotic surgery was the 46 cases and of laparoscopic surgery was the 54 cases. Comparison between 1st phase and 2nd phase in the robotic group showed significant difference in the total operation time and in docking and surgeon console time. Other perioperative characteristics did not differ significantly between the phases of the learning curve. For the laparoscopic group, there was also a decrease in the operation time after the 1st phase of the learning curve, as well as a statistically significant decrease in intraoperative blood loss (140.9 ± 68.8 ml for 1st phase versus 108.1 ± 67.8 ml for 2nd phase, p = 0.009). All cases of conversion in the laparoscopic group were in the 1st phase of the learning curve (p = 0.047). Comparison between 1st phase and 2nd phase for laparoscopic surgery showed no significant difference for the short-term outcomes. Pathologic outcomes were not significantly different in both procedures and phases. Conclusions. The learning curve for robotic surgery was shorter than for laparoscopic surgery. There were no significant differences in perioperative clinicopathologic characteristics and short-term outcomes in both procedures and phases of the learning curve.