Long-term Outcomes of Robot-assisted Versus Laparoscopic Surgery for Colon Cancer

Objective: To determine long-term survival in patients undergoing robot-assisted (RAS) or laparoscopic surgery (LAS) for colon cancer. Background: The potential long-term benefits of RAS compared to LAS for colon cancer are not well examined. Using a register-based approach, we aimed to compare these two surgical platforms in an analysis of long-term outcomes, including recurrence-free survival and all-cause- and colon cancer-specific mortality. Methods: A nationwide register-based cohort study of patients with Union for International Cancer Control (UICC) stage I-III colon cancer undergoing planned RAS or LAS from 2010 through 2018. Patient demographic, clinical, and pathological data were retrieved from Danish national registers. Survival- and recurrence rates were estimated by Cox proportional hazard multivariate regression analysis adjusting for baseline covariates. Results: A total of 7,565 patients (LAS=6,905 (91%) and RAS=660 (9%)) were included in the complete case survival analysis. Patients undergoing LAS had a significantly increased risk of cancer recurrence (LAS=1,178 (17.1%), RAS=82 (12.4%), P =0.002) with a mean follow-up time of 4.93 years (standard deviation 2.47). The survival analysis of recurrence-free survival favored RAS (hazard ratio adjusted =0.80, 95% confidence interval [0.64-1.00], P =0.049). No associations between the two surgical platforms were evident regarding all-cause (hazard ratio adjusted =0.98, 95% confidence interval [0.82-1.17], P =0.783) or colon cancer-specific mortality (hazard ratio adjusted =0.89, 95% confidence interval [0.67-1.18], P =0.405). Conclusion: Adopting RAS for colon cancer was associated with improved recurrence free-survival. However, it did not cause a lower all-cause- or colon cancer-specific mortality.