Implementation of a standardized surgical technique in robot-assisted restorative rectal cancer resection: a single center cohort study.

BACKGROUND: Despite increasing focus on the technical performance of total mesorectal excision over recent decades, anastomotic leakage (AL) continues to be a serious complication for many patients, even in the hands of experienced surgical teams. This study describes implementation of standardized surgical technique in an effort to reduce variability, decrease the risk of anastomotic leakage, and improve associated short-term outcomes for rectal cancer patients undergoing robot-assisted restorative rectal resection (RRR). METHODS: We evaluated all rectal cancer patients undergoing robot-assisted RRR at Aarhus University Hospital between 2017 and 2020. Six standardized surgical steps directed to improve anastomotic healing were mandatory for all RRR. Additional changes were made during the period with prohibition of systemic dexamethasone and limiting the use of endoscopic stapling devices. RESULTS: The use of the full standardization, including all six surgical steps, increased from 40.3% (95% CI, 0.28-0.54) to 86.2% (95% CI, 0.68-0.95). The incidence of AL decreased from 21.0% (95% CI, 0.12-0.33) to 6.9% (95% CI, 0.01-0.23). Length of hospital stay (LOS) decreased from 6 days (range 2-50) to 5 days (range 2-26). The rate of patients readmitted within 90 days decreased from 21.0% (95% CI, 0.12-0.33), to 6.9% (95% CI, 0.01-0.23). CONCLUSION: The full standardization was effectively implemented for rectal cancer patients undergoing robot-assisted RRR. The risk of AL, LOS and readmission decreased during the study period. A team focus on high-reliability and peri-operative complications can improve patient outcomes.

Conversion to open from laparoscopic colon resection is a marker for worse oncologic outcomes in colon cancer.

BACKGROUND: This study aimed to evaluate the oncological outcomes of conversion in patients undergoing resection for colon cancer. METHODS: Patients with stages I-III colon adenocarcinoma operated on between 2000 and 2012 were included. Oncologic outcomes were assessed by surgical approach (laparoscopy vs. open). A secondary analysis compared patients who required conversion to open vs. laparoscopic only. RESULTS: We identified 1196 patients that met inclusion criteria (28% laparoscopic, 72% open). Overall, 13% of laparoscopic cases were converted to open. There were no differences in 5-year overall survival (OS) (p = 0.258), disease-free survival, (DFS) (p = 0.070), cancer-specific survival (CSS) (p = 0.207), or recurrence (p = 0.216) between laparoscopy and open surgery. However, patients with conversion had a worse OS (p = 0.010) and DFS (p = 0.006) when compared to laparoscopic only. CONCLUSION: Conversion from laparoscopic to open surgery is a marker for worse survival outcomes. Further investigation is needed to define the underlying cause of these differences.