A US study indicates that among patients with colorectal cancer, the use of robotic surgery increased from 1.7% in 2010 to 27.0% by 2020. By that year, it accounted for 48.8% of all rectal cancer procedures.
The rise of robotic-assisted surgery has been a key factor in the increased adoption of minimally invasive surgery (MIS) for patients with colorectal cancer, according to study results published in Diseases of the Colon & Rectum.
Over the past decade, MIS, including robotic and laparoscopic approaches, has become increasingly prominent in the management of colorectal cancer.
This is because of its superior short-term outcomes and oncologic results comparable to open surgery.
However, concerns about accessibility and costs have limited its adoption in some facilities, leaving disparities in patient care.
In a retrospective observational cohort study using data from the National Cancer Database (NCDB), researchers analysed management approaches for 475,001 adults aged 18 to 90 who had been diagnosed with non-metastatic colon (82.1%) or rectal adenocarcinoma (17.9%) between 2010 and 2020.
The NCDB is a facility-based registry jointly managed by the American Cancer Society and the American College of Surgeons Commission on Cancer (CoC). It contains comprehensive patient-level data on nearly three-fourths of new cancer diagnoses from more than 1,500 CoC-accredited facilities.
Rates of minimally invasive surgery for colorectal cancer steadily increased across all types of facilities from 2010 to 2020.
Primary outcomes included the prevalence of open, laparoscopic, and robotic surgeries across facilities, with a focus on trends in adoption, facility resources, and patient demographics.
Secondary outcomes included conversion rates to open surgery, 30-day readmission and mortality rates, and postoperative inpatient lengths of stay.
The researchers found that 40.5% of patients underwent open surgery, 45.9% had laparoscopic surgery, and 13.7% received robotic surgery. MIS increased across all facility types during the study period, with robotic-assisted surgery driving this trend.
In terms of colon cancer management, laparoscopic MIS peaked in 2016 at 54.0% of procedures. After this, the rates of robotic surgery increased from 1.7% in 2010 to 9.2% in 2015, and then jumped to 27.0% in 2020.
For rectal cancer, laparoscopic MIS peaked in 2014 at 37.2% of procedures, while rates of robotic-assisted surgery continued to rise, making up 48.8% of procedures by 2020 (compared to 5.5% in 2010 and 24.7% in 2015). Open surgeries for colon and rectal cancers saw a significant decline during the study period.
Facilities with robotic capabilities had greater overall MIS adoption than those without, for which MIS utilisation plateaued at 58%. Factors like higher facility case volume and patient income were associated with an increased likelihood of patients undergoing MIS.
In contrast, lower income, Black and residents in rural areas were linked to lower utilisation of MIS for both colon and rectal cancer resections.
Younger patients (aged less than 75 years) and those with private insurance were more likely to undergo robotic surgery.
Robotic surgery demonstrated lower rates of conversion to open procedures (6.3% of robotic vs 12.6% of laparoscopic surgeries; P <.001) and better postoperative outcomes, including lower 30-day mortality rates (0.8% with robotic vs 1.5% with laparoscopic vs 3.5% with open surgery; P <.001).
This study's limitations include its reliance on data from Coc-accredited facilities, which could limit findings.
Additionally, information from the NCDB did not take into account surgeon-level or facility-level factors, nor the decision-making processes that may underlie MIS utilisation.
The researchers concluded: ‘Rates of minimally invasive surgery for colorectal cancer steadily increased across all facility types from 2010 through 2020.’
They added: ‘For [patients with] colon and rectal cancer, rates of open resections declined and laparoscopic resections plateaued, but robotic surgery continues to increase. Robot-assisted surgery is now the most common approach for rectal cancer surgery.’
