Abstract
PurposeLaparoscopic rectal surgery in obese patients is technically challenging. The technological advantages of robotic instruments can help overcome some of those challenges, but whether this translates to superior short-term outcomes is largely unknown. The aim of this study is to compare the short-term surgical outcomes of obese (BMI ≥ 30) robotic and laparoscopic rectal cancer surgery patients.MethodsAll consecutive obese patients receiving laparoscopic and robotic rectal cancer resection surgery from three centres, two from the UK and one from Portugal, between 2006 and 2017 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for ASA grade, neoadjuvant radiotherapy and pathological T stage. Their short-term outcomes were examined.ResultsA total of 222 patients were identified (63 robotic, 159 laparoscopic). The 63 patients who received robotic surgery were matched with 61 laparoscopic patients. Cohort characteristics were similar between the two groups. In the robotic group, operative time was longer (260 vs 215 min; p = 0.000), but length of stay was shorter (6 vs 8 days; p = 0.014), and thirty-day readmission rate was lower (6.3% vs 19.7%; p = 0.033).ConclusionsIn this study population, robotic rectal surgery in obese patients resulted in a shorter length of stay and lower 30-day readmission rate but longer operative time when compared to laparoscopic surgery. Robotic rectal surgery in the obese may be associated with a quicker post-operative recovery and reduced morbidity profile. Larger-scale multi-centre prospective observational studies are required to validate these results.
Highlights
IntroductionPortsmouth, James Watson West, 2 King Richard 1st road, Portsmouth PO1 2FR, UK 3 Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal 4 Bournemouth University School of Health and Social Care, Bournemouth, UK open surgery such as shorter hospital stay, earlier return to normal function, less postoperative pain, early mobilisation and improved cosmesis [1,2,3,4,5,6]
Laparoscopic colorectal surgery has become the new standard for colorectal diseases as it offers several advantages overPortsmouth, James Watson West, 2 King Richard 1st road, Portsmouth PO1 2FR, UK 3 Champalimaud Foundation, Av
Several studies indicate that obesity is a risk factor for worse short-term surgical outcomes in laparoscopic colorectal surgery [27,28,29]. This is still a subject of debate, with numerous studies demonstrating no difference in short-term outcomes between laparoscopic obese and non-obese colorectal surgery patients [30, 31]
Summary
Portsmouth, James Watson West, 2 King Richard 1st road, Portsmouth PO1 2FR, UK 3 Champalimaud Foundation, Av. Brasilia, 1400-038 Lisbon, Portugal 4 Bournemouth University School of Health and Social Care, Bournemouth, UK open surgery such as shorter hospital stay, earlier return to normal function, less postoperative pain, early mobilisation and improved cosmesis [1,2,3,4,5,6]. There is consensus amongst surgeons that obesity increases the technical difficulty of colorectal surgery [7, 8]. Obese patients tend to have a thickened and excessive omentum and mesentery which restricts the space for instrumental manoeuvre, limits access and vision, distorts the surgical planes and can lead to problematic bleeding [9]. With obesity becoming increasingly a major hazard to public health worldwide, colorectal surgeons are likely to encounter and operate on this group of patients in increasing numbers [10, 11].
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