Introduction

There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS.

Methods

Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models.

Results

A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses.

In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21–0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26–0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26–0.95, p = 0.036).

Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033).

Conclusions

The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile.

介绍

越来越多的证据表明，与腹腔镜手术（LS）或开放手术（OS）相比，在结直肠癌切除中使用机器人辅助手术（RAS）可以改善短期结果，这可能是通过减少全身炎症反应来实现的。先生）。血清 C 反应蛋白 (CRP) 是一种敏感的 SIR 生物标志物，其在术后并发症早期识别中的效用已在各种外科手术中得到验证。描述 RAS 术后 SIR 特征的研究仍然很少。

方法

对前瞻性收集的连续患者数据库进行回顾性研究，这些患者在单个高容量单位中接受左侧癌和直肠癌的 OS、LS 和 RAS 治疗。回顾了患者和疾病特征、术后 CRP 水平和临床结果，并在二元逻辑回归和倾向评分匹配模型中探讨了它们之间的关系。

结果

总共纳入 1031 名患者（483 名 OS、376 名 LS 和 172 名 RAS）。在未经调整的分析中，与 OS 相比，RAS 和 LS 与术后前 4 天较低的 CRP 水平相关 ( p  < 0.001)，并且并发症和住院时间减少。

在二元 Logistic 回归模型中，RAS 与术后第 3 天较低的 CRP 水平独立相关（OR 0.35，95% CI 0.21–0.59，p  < 0.001）以及所有并发症发生率的降低（OR 0.39，95%） CI 0.26–0.56，p  < 0.001）和主要并发症（OR 0.5，95% CI 0.26–0.95，p  = 0.036）。

在专门比较 LS 与 RAS 的倾向评分匹配模型中，RAS 与术后前两天较低的术后 CRP 水平相关，第 3 天 CRP ≥ 150 mg/L 的患者比例较低（20.9%对比 30.5%，p  = 0.036），并且所有并发症的发生率较低（34.7% 对比 46.7%，p  = 0.033）。

结论

目前的观察性研究表明，RAS 方法与较低的术后 SIR 和更好的术后并发症相关。