The rise of robotics: Surgical approaches for rectal cancer over time

摘要

BACKGROUND: Robotic surgery for rectal cancer has gained attention for addressing anatomic challenges, though concerns about cost, operative time, and oncologic outcomes persist. Studies on laparoscopic surgery initially showed mixed results regarding long-term oncologic safety, but current data is favorable. Evidence supporting the robotic approach remains limited. This study examined trends in robotic surgery, including facilitation of high-quality oncologic resection, defined by lymph node yield and negative margins, using National Cancer Database (NCDB) data. METHODS: A multicenter cohort study analyzed 87,611 patients with stage I-III rectal cancer undergoing definitive resection between 2010 and 2021. Outcomes included robotic surgery rates, high-quality oncologic resection (defined using lymph node yield and surgical margins), length of stay, 30-day readmission, and mortality. Outcomes were stratified into tertiles (2010-2013, 2014-2017, 2018-2021) and analyzed via univariate analysis and multivariate logistic regressions. RESULTS: Robotic surgery use rose from 10.1% (2010-2013) of oncologic resection to 45.7% (2018-2021) (p < 0.001). High-quality oncologic resection improved over time: 65.4% to 75.3% (p < 0.001). Compared to open surgery, robotic surgery had 1.39 times higher odds of achieving high-quality oncologic resection (p < 0.001). Despite both improving over time, robotics had higher odds than laparoscopic surgery of high-quality oncologic resection in each tertile (e.g., 2018-2021 OR 1.64, CI 1.49-1.81 vs. OR 1.44, CI 1.30-1.61; respectively). High-volume centers further increased the likelihood of successful outcomes (OR 1.6, p < 0.001). Robotic and laparoscopic approaches were associated with significantly lower mortality compared to open surgery (OR 0.63, p < 0.001; OR 0.72, p < 0.001, respectively). CONCLUSION: Robotic surgery has significantly improved in oncologic measures, including rates of quality surgical resection and patients' overall survival, over the past decade, outperforming laparoscopic and open techniques. These findings underscore the growing role of robotic surgery in rectal cancer care and the need for formalized training and credentialing to ensure continued progress and equitable access to this technology.