Of patients who underwent urgent or emergent CRC surgery, 64.4% had open surgery, 31.9% underwent laparoscopic procedures, and 3.7% had robotic surgery.
Among select patients undergoing surgery for colorectal cancer (CRC), robotic surgery conferred lower conversion rates to open surgery and fewer surgical complications compared to laparoscopy, according to results from a retrospective analysis published in the Journal of the American College of Surgeons.
Specifically, among 83,483 patients who underwent urgent or emergent colorectal surgery, surgical complications were significantly lower among patients treated with robotic surgery vs laparoscopy (OR, 0.65; 95% CI, 0.60-072; P <.001). Additionally, open surgery was associated with an increased risk of surgical complications compared to laparoscopy (OR, 2.04; 95% CI, 1.97-2.12; P <.001). Furthermore, the strongest predictors of surgical complication rates included American Surgical Association (ASA) class 4 to 5 (OR, 2.43; 95% CI, 2.30-2.57), septic shock (OR, 10.88; 95% CI, 9.69-12.21), and total functional dependence (OR, 1.62; 95% CI, 1.42-1.85).
Robotic surgery showed a lower risk of medical complications compared with laparoscopy (OR, 0.79; 95% CI, 0.68-0.93; P = .005). Compared with laparoscopy, open surgery was associated with a higher risk of medical complications (OR, 1.62; 95% CI, 1.54-1.70; P <.001). ASA class 4 to 5 (OR, 4.02; 95% CI, 3.74-4.31) and septic shock (OR, 5.53; 95% CI, 5.16-5.94) were also both strong predictors of medical complications, as well as colitis (OR, 1.53; 95% CI, 1.34-1.75).
Further findings revealed that the unadjusted conversion rate to open surgery between robotic vs laparoscopic cases was 7.8% vs 24.2%. This difference was significant across analytical approaches, including multivariable logistic regression (OR, 0.32; 95% CI, 0.28-0.36; P <.001), propensity score matching (OR, 0.21; 95% CI, 0.18-0.25; P <.001), and g-computation analysis (OR, 0.34; 95% CI, 0.29-0.38; P <0.001).
“Robotic surgery represents a viable and advantageous approach for emergency colorectal surgery, with lower conversion rates to open surgery and improved postoperative outcomes compared to both laparoscopic and open approaches,” lead author Davide Ferrari, MD, general surgery resident in the Division of Colon and Rectal Surgery of the Department of Surgery at Mayo Clinic, wrote in the publication with study coinvestigators. “While patient selection remains important, our findings indicate that the technical advantages of the robotic platform persist even in more complex cases, suggesting broader applicability than previously considered. The projected increase in robotic utilization to 20.2% of emergency colorectal procedures by 2025 reflects the growing acceptance of this technology.”
Patient data in the retrospective study were collected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Risk-adjusted data were gathered from medical charts and included an assessment of a patient’s condition 30 days after a surgical procedure. A random sample of about 20% of the total cases formed the final dataset.
Those who underwent open, laparoscopic, or robotic colectomy in the “Targeted Colectomy” file within the ACS-NSQIP were included in the study, with data ranging from January 2012 to December 2021.
Of patients who underwent urgent or emergent CRC surgery, 64.4% had open surgery, 31.9% underwent laparoscopic procedures, and 3.7% had robotic surgery. Notable characteristic differences included a higher proportion of White (81.6%) and obese patients (41.6%), classified as a BMI of greater than 30 kg/m2, among those who underwent robotic surgery. A lower proportion of patients older than 80 years (6.1%) were selected for a robotic procedure.
The primary end points of the study were overall complications, medical and surgical complications, conversion rate to open surgery, and length of hospital stay. Secondary end points included an analysis of the trends of open, laparoscopic, and robotic surgery in emergent colon and rectal surgery, and an analysis of how surgical procedures were decided upon.
Notably, 77.2% of CRC emergency surgeries were performed via an open approach at the start of the study period (2012), and no robotic surgeries were performed. By June 2021, open surgery accounted for 61.2% of these cases, with laparoscopy and robotic surgeries accounting for 32.2% and 6.6% of cases, respectively.
Reference
Ferrari D, Violante T, Novelli M, et al. Robotic surgery in emergency colorectal procedures: analysis of outcomes and future. J Am Coll Surg. Published July 23, 2025. doi:10.1097/XCS.0000000000001500