Robotic-assisted intracorporeal versus extracorporeal techniques in sigmoidectomy: a propensity score-matched analysis

The impact of sarcopenia on postoperative complications and survival outcomes after robotic colorectal cancer surgery: a study based on single-center propensity score matching

Sarcopenia is more common in elderly individuals and is often associated with functional limitations, which can affect postoperative clinical efficacy and mortality rates in cancer surgery. Yet, the precise effects of sarcopenia on individuals receiving robotic colorectal cancer surgery (RCRC) remain insufficiently explored. Our objective was to evaluate the value of preoperative skeletal muscle status on patients receiving RCRC about postoperative complications and long-term prognosis. Data were gathered retrospectively for patients with well-defined conditions. Clinical records of patients who underwent RCRC at a single center between January 2019 and September 2022 were analyzed. Sarcopenia was defined using preoperative computed tomography (CT) body composition analysis of the L3 vertebral level muscle index with cutoff values of < 29 cm2/m2 for females and < 36 cm2/m2 for males. In this retrospective study, 432 patients were sequentially sampled, and 127 pairs were formed through propensity score matching to contrast sarcopenic and non-sarcopenic patients. Relative to the non-sarcopenia group (NSCA), the sarcopenia group (SCA) showed increased rates of complications after matching (P = 0.045), especially in cases of wound and pulmonary infections (P = 0.0408). Compared to the NSCA group, the SCA group exhibited reduced rates of 3-year overall survival (OS) and disease-free survival (DFS) (P = 0.048, 0.036). Additionally, the SCA group experienced extended hospitalizations (P = 0.04) and heightened inflammatory indices before and after surgery (P = 0.028, 0.049). Sarcopenia before surgery in RCRC patients correlates with heightened post-surgery complications and lower rates of short-term survival. Conducting sarcopenia screenings before surgery could assist in evaluating risks and developing post-surgery management approaches for these patients.

Robotic approach to colonic resection: For some or for all patients?

The robotic approach is rapidly gaining momentum in colorectal surgery. Its benefits in pelvic surgery have been extensively discussed and are well established amongst those who perform minimally invasive surgery. However, the same cannot be said for the robotic approach for colonic resection, where its role is still debated. Here we aim to provide an extensive debate between selective and absolute use of the robotic approach for colonic resection by combining the thoughts of experts in the field of robotic and minimally invasive colorectal surgery, dissecting all key aspects for a critical view on this exciting new paradigm in colorectal surgery.

Robotic ambulatory colorectal resections: a systematic review

Colorectal surgery has progressed greatly via minimally invasive techniques, laparoscopic and robotic. With the advent of ERAS protocols, patient recovery times have greatly shortened, allowing for same day discharges (SDD). Although SDD have been explored through laparoscopic colectomy reviews, no reviews surrounding robotic ambulatory colorectal resections (RACrR) exist to date. A systematic search was carried out across three databases and internet searches. Data were selected and extracted by two independent reviewers. Inclusion criteria included robotic colorectal resections with a length of hospital stay of less than one day or 24 h. 4 studies comprising 136 patients were retrieved. 56% of patients were female and were aged between 21 and 89 years. Main surgery indications were colorectal cancer and recurrent sigmoid diverticulitis (43% each). Most patients had low anterior resections (48%). Overall, there was a 4% complication rate postoperatively, with only 1 patient requiring readmission due to postoperative urinary retention (< 1%). Patient selection criteria involved ASA score cut-offs, nutritional status, and specific health conditions. Protocols employed shared similarities including ERAS education, transabdominal plane blocks, early removal of urinary catheters, an opioid-sparing regime, and encouraged early oral intake and ambulation prior to discharge. All 4 studies had various follow-up methods involving telemedicine, face-to-face consultations, and virtual ward teams. RACrRs is safe and feasible in a highly specific patient population; however, further high-quality studies with larger sample sizes are needed to draw more significant conclusions. Several limitations included small sample size and the potential of recall bias due to retrospective nature of 2 studies.

Robot-assisted radical resection of colorectal cancer using the KangDuo surgical robot versus the da Vinci Xi robotic system: short-term outcomes of a multicentre randomised controlled noninferiority trial

BACKGROUND

The KangDuo surgical robot (KD-SR-01) was recently developed in China. This study aims to evaluate the short-term outcomes of KD-SR-01 for colorectal cancer surgery.

METHODS

This is a multicentre randomised controlled noninferiority trial conducted in three centers in China. Enrolled patients were randomly assigned at a 1:1 ratio to receive surgery using the KD-SR-01 system (KD group) or the da Vinci Xi (DV) robotic system (DV group). The primary endpoint was the success rate of operation. The second endpoints were surgical outcomes, pathological outcomes, and postoperative outcomes.

RESULTS

Between July 2022 and May 2023. A total of 100 patients were included in the trial and randomly assigned to the KD group (50 patients) and the DV group (50 patients). All cases were completed successfully without conversion to laparoscopic surgery. The time to flatus and the incidence of postoperative complications of Clavien-Dindo grade II or higher grade were comparable between the two groups. Surgeons reported a high level of comfort with the KD-SR-01 system. In the subgroup analysis of different operative procedures, there were no significant differences in docking time, console time, blood loss, and the length of the incision for extraction between the two groups. There were no differences in pathological outcomes including maximum tumor diameter, circumferential resection margin, distal resection margin, and number of harvested lymph nodes.

CONCLUSIONS

The KD-SR-01 system was a viable option for colorectal cancer robotic surgery, with acceptable short-term outcomes comparable to the da Vinci Xi robotic system.