Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery?

Abstract

Aims: To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion.

Materials and methods: A US-based database study was conducted utilizing the 2012–2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RA\LS patients (n = 533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample.

Results: Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p = .7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p < .0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p < .0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals.

Limitations: Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics.

Conclusions: Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.

Keywords:

• Rectal resection
• rectal cancer
• robotic-assisted
• laparoscopic
• conversion
• complication

Transparency

Declaration of funding

This study was sponsored by Intuitive Surgical, Inc (Sunnyvale, CA).

Declaration of financial/other relationships

SJA, SD, and RB served as consultants to Intuitive Surgical, Inc. through their employment at Covance. As salaried employees of Covance they did not receive any direct compensation. MH did not receive funding support for this study, but received compensation from Intuitive Surgical as a consultant faculty for training and education for robotic-assisted surgery. EL, SM, and ST are employees of Intuitive Surgical, Inc. Intuitive Surgical is a manufacturer of the da Vinci® Surgical System, which is used to perform various surgical procedures, including the robotic-assisted rectal resection procedure described in this study. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

The study was presented at the AcademyHealth 2016 Annual Research Meeting, Boston, MA, June 26–28, 2016.

Acknowledgments

The authors would like to acknowledge the contributions of Ali Andreasen for her clinical and analytic support, as well as Karolina Badora for her editorial support.