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Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis

Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by previous subgroup analyses. We performed a retros...

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Autores principales: Glencer, Alexa C., Lin, Joseph A., Trang, Karen, Greenberg, Anya, Kirkwood, Kimberly S., Adam, Mohamed Abdelgadir, Sarin, Ankit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer London 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9365884/
https://www.ncbi.nlm.nih.gov/pubmed/35147841
http://dx.doi.org/10.1007/s11701-022-01380-2
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author Glencer, Alexa C.
Lin, Joseph A.
Trang, Karen
Greenberg, Anya
Kirkwood, Kimberly S.
Adam, Mohamed Abdelgadir
Sarin, Ankit
author_facet Glencer, Alexa C.
Lin, Joseph A.
Trang, Karen
Greenberg, Anya
Kirkwood, Kimberly S.
Adam, Mohamed Abdelgadir
Sarin, Ankit
author_sort Glencer, Alexa C.
collection PubMed
description Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by previous subgroup analyses. We performed a retrospective review of 2016–2018 National Surgery Quality Improvement Program (NSQIP) data to compare outcomes between patients who underwent robotic versus laparoscopic proctectomy, stratified by Body Mass Index (BMI) subgroups. We also compared outcomes of converted minimally invasive proctectomy to planned open operations. Four thousand four hundred eighteen (69.3%) patients underwent laparoscopic proctectomy, and 1956 (30.7%) patients underwent robotic proctectomy. Robotic proctectomy was associated with a significantly lower conversion rate compared to laparoscopic proctectomy (5.1% vs 12.3%; p = 0.002), and this relationship was maintained on an adjusted model. Obese (BMI > 30) patients were more likely to require conversion in both laparoscopic and robotic groups with the greatest difference in the conversion rate in the obese subgroup. Patients who underwent conversion had higher composite morbidity compared to patients who underwent planned open operations (50.8% vs 41.3%; p < 0.001). And among patients with rectal cancer, robotic proctectomy was associated with a greater incidence of positive radial tumor margins compared to laparoscopic proctectomy (8.0% vs 6.4%; p = 0.039), driven primarily by the obese subgroup. Our study demonstrates that robotic proctectomy is associated with a 7% lower conversion rate compared to laparoscopy and that obese patients are more likely to require conversion than non-obese patients. Among obese patients with rectal cancer, we identified an increased risk of positive radial margins with robotic compared to laparoscopic proctectomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11701-022-01380-2.
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spelling pubmed-93658842022-10-28 Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis Glencer, Alexa C. Lin, Joseph A. Trang, Karen Greenberg, Anya Kirkwood, Kimberly S. Adam, Mohamed Abdelgadir Sarin, Ankit J Robot Surg Original Article Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by previous subgroup analyses. We performed a retrospective review of 2016–2018 National Surgery Quality Improvement Program (NSQIP) data to compare outcomes between patients who underwent robotic versus laparoscopic proctectomy, stratified by Body Mass Index (BMI) subgroups. We also compared outcomes of converted minimally invasive proctectomy to planned open operations. Four thousand four hundred eighteen (69.3%) patients underwent laparoscopic proctectomy, and 1956 (30.7%) patients underwent robotic proctectomy. Robotic proctectomy was associated with a significantly lower conversion rate compared to laparoscopic proctectomy (5.1% vs 12.3%; p = 0.002), and this relationship was maintained on an adjusted model. Obese (BMI > 30) patients were more likely to require conversion in both laparoscopic and robotic groups with the greatest difference in the conversion rate in the obese subgroup. Patients who underwent conversion had higher composite morbidity compared to patients who underwent planned open operations (50.8% vs 41.3%; p < 0.001). And among patients with rectal cancer, robotic proctectomy was associated with a greater incidence of positive radial tumor margins compared to laparoscopic proctectomy (8.0% vs 6.4%; p = 0.039), driven primarily by the obese subgroup. Our study demonstrates that robotic proctectomy is associated with a 7% lower conversion rate compared to laparoscopy and that obese patients are more likely to require conversion than non-obese patients. Among obese patients with rectal cancer, we identified an increased risk of positive radial margins with robotic compared to laparoscopic proctectomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11701-022-01380-2. Springer London 2022-02-11 2022 /pmc/articles/PMC9365884/ /pubmed/35147841 http://dx.doi.org/10.1007/s11701-022-01380-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Glencer, Alexa C.
Lin, Joseph A.
Trang, Karen
Greenberg, Anya
Kirkwood, Kimberly S.
Adam, Mohamed Abdelgadir
Sarin, Ankit
Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis
title Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis
title_full Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis
title_fullStr Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis
title_full_unstemmed Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis
title_short Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis
title_sort assessing the role of robotic proctectomy in obese patients: a contemporary nsqip analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9365884/
https://www.ncbi.nlm.nih.gov/pubmed/35147841
http://dx.doi.org/10.1007/s11701-022-01380-2
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