Unplanned Robotic-Assisted Conversion-to-Open Colorectal Surgery is Associated with Adverse Outcomes View Full Text


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Article Info

DATE

2018-06

AUTHORS

Yongjin F. Lee, Jeremy Albright, Warqaa M. Akram, Juan Wu, Jane Ferraro, Robert K. Cleary

ABSTRACT

BACKGROUND: Laparoscopic conversion-to-open colorectal surgery is associated with worse outcomes when compared to operations completed without conversion. Consequences of robotic conversion have not yet been determined. The purpose of this study is to compare short-term outcomes of converted robotic colorectal cases with those that are completed without conversion, as well as with cases done by the open approach. METHODS: The ACS-NSQIP database was queried for patients who underwent robotic completed, robotic converted-to-open, and open colorectal resection between 2012 and 2015. Propensity scores were estimated using gradient-boosted machines and converted to weights. Generalized linear models were fit using propensity score-weighted data. RESULTS: A total of 25,253 patients met inclusion criteria-21,356 (84.5%) open, 3663 (14.5%) robotic completed, and 234 (0.9%) conversions. Conversion rate was 6.0%. Converted cases had significantly higher 30-day mortality rate, higher complication rate, and longer hospital length of stay than completed cases. Converted patients also had significantly higher rates of the following complications: surgical site infections, cardiac complications, deep venous thrombosis, postoperative ileus, postoperative re-intubation, renal failure, and 30-day reoperation. Compared to the open approach, converted patients had significantly more cardiac complications, postoperative reintubation, and longer operating times with no significant difference in 30-day mortality. CONCLUSIONS: Unplanned robotic conversion-to-open is associated with worse outcomes than completed cases and outcomes that more closely resemble traditional open colorectal surgery. Patients should be counseled with regard to minimally invasive conversion rates and outcomes. The continued pursuit of technological advancements that decrease the risk for conversion in minimally invasive colorectal surgery is clearly warranted. More... »

PAGES

1059-1067

References to SciGraph publications

  • 2017-06. Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis in SURGICAL ENDOSCOPY
  • 2008-12. Conversion of laparoscopic colon resection does not affect survival in colon cancer in SURGICAL ENDOSCOPY
  • 2013-12. Robotic-assisted Colorectal Surgery in the United States: A Nationwide Analysis of Trends and Outcomes in WORLD JOURNAL OF SURGERY
  • 2017-05. A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy in LANGENBECK'S ARCHIVES OF SURGERY
  • 2017-02. Cancer recurrence following conversion during laparoscopic colorectal resections: a meta-analysis in AGING CLINICAL AND EXPERIMENTAL RESEARCH
  • 2016-02. A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery in SURGICAL ENDOSCOPY
  • 2015-05. Risk Factors for Conversion of Laparoscopic Colorectal Surgery to Open Surgery: Does Conversion Worsen Outcome? in WORLD JOURNAL OF SURGERY
  • 2008-04. Conversion rate in 300 laparoscopic rectal resections and its influence on morbidity and oncological outcome in INTERNATIONAL JOURNAL OF COLORECTAL DISEASE
  • 2009-11. Conversion in laparoscopic surgery: does intraoperative complication influence outcome? in SURGICAL ENDOSCOPY
  • 2008-12. Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer in SURGICAL ENDOSCOPY
  • 2006-06. Converted laparoscopic colectomy in SURGICAL ENDOSCOPY
  • 2011-01. Redefining Conversion in Laparoscopic Colectomy and Its Influence on Outcomes: Analysis of 418 Cases from a Single Institution in WORLD JOURNAL OF SURGERY
  • 2016-06. Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2017-05. Conversions in laparoscopic surgery for rectal cancer in SURGICAL ENDOSCOPY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11605-018-3706-0

    DOI

    http://dx.doi.org/10.1007/s11605-018-3706-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1101056891

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/29450825


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        "description": "BACKGROUND: Laparoscopic conversion-to-open colorectal surgery is associated with worse outcomes when compared to operations completed without conversion. Consequences of robotic conversion have not yet been determined. The purpose of this study is to compare short-term outcomes of converted robotic colorectal cases with those that are completed without conversion, as well as with cases done by the open approach.\nMETHODS: The ACS-NSQIP database was queried for patients who underwent robotic completed, robotic converted-to-open, and open colorectal resection between 2012 and 2015. Propensity scores were estimated using gradient-boosted machines and converted to weights. Generalized linear models were fit using propensity score-weighted data.\nRESULTS: A total of 25,253 patients met inclusion criteria-21,356 (84.5%) open, 3663 (14.5%) robotic completed, and 234 (0.9%) conversions. Conversion rate was 6.0%. Converted cases had significantly higher 30-day mortality rate, higher complication rate, and longer hospital length of stay than completed cases. Converted patients also had significantly higher rates of the following complications: surgical site infections, cardiac complications, deep venous thrombosis, postoperative ileus, postoperative re-intubation, renal failure, and 30-day reoperation. Compared to the open approach, converted patients had significantly more cardiac complications, postoperative reintubation, and longer operating times with no significant difference in 30-day mortality.\nCONCLUSIONS: Unplanned robotic conversion-to-open is associated with worse outcomes than completed cases and outcomes that more closely resemble traditional open colorectal surgery. Patients should be counseled with regard to minimally invasive conversion rates and outcomes. The continued pursuit of technological advancements that decrease the risk for conversion in minimally invasive colorectal surgery is clearly warranted.", 
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