colorectal surgery

Single-Port Robotic Colorectal Surgery ‘Safe, Feasible,’ With Good Outcomes

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A phase 2 clinical trial of single-port robotic colorectal surgery shows it to be feasible and safe with good clinical outcomes, according to new research. The findings were presented at the 2022 annual meeting of the American Society of Colon and Rectal Surgeons (abstract S29).

John Marks, MD, of the Division of Colorectal Surgery at Lankenau Medical Center, in Wynnewood, Pa., described the short- and long-term outcomes of the first phase 2 trial using the single-port robot for colorectal surgery. From October 2018 to August 2021, researchers selected consecutive patients who underwent single-port robotic surgery at Lankenau Medical Center. Study inclusion required patients to have had a need for colorectal resection. Patients who had emergency surgery, were pregnant, were younger than 18 years of age, had stage IV carcinoma or had an inability to provide consent were excluded from the study. All operations were performed by one surgeon at Lankenau Medical Center.

The study cohort included 133 patients. The mean age was 59.7 years and 57.9% of patients were women. The mean body mass index was 27.5 kg/m2. Sixty-five patients had adenocarcinoma, 27 had diverticulitis, 21 had adenoma polyps, seven had ulcerative colitis and the rest had other conditions. The procedure was performed via transanal excision in 57.1% of the cases and an abdominal approach in 42.9%. The single-port colorectal surgery case mix represented a full spectrum of operations.

Single-port colorectal surgery was completed without laparoscopic ports in 96.9% of the cases. There were no conversions to open surgery and four (3%) to laparoscopy. There were no intraoperative complications and no transfusions were necessary. Median docking time was 6.1 minutes, median console time was 215 minutes and median operative time was 307.0 minutes. The mean abdominal incision was 5.5 cm. Ninety-seven percent were completed with one incision. Overall morbidity was 13.5% and included urinary retention (n=2), anastomotic leak (n=1) and pelvic abscess (n=2). In terms of oncologic outcomes, there were no local recurrences and negative margins were 100%. There was one distant metastasis to the lungs.

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“We demonstrate that single-port robotic colorectal surgery is safe, feasible and can achieve good clinical outcomes,” Dr. Marks said.

Rebecca E. Hoedema, MD, MS, FACS, FACRS, of Spectrum Health Medical Group Colon and Rectal Surgery Center for Digestive Diseases, Ferguson Clinic, in Grand Rapids, Mich., was asked to comment on the study and said the findings provided a good overview of the single-surgeon practice. “It is an interesting, single-surgeon experience that may not translate to all practices,” Dr. Hoedema said.

NSAIDs Linked to Leaks After GI Surgery

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Anastomotic leak association found in a statewide cohort study.

Postoperative nonsteroidal anti-inflammatory drug (NSAID) use was associated with anastomotic leak after nonelective colorectal surgery in a population-based surgical database.

The painkillers were associated with a 24% elevated risk for anastomotic leak at the surgical junction after adjustment for other factors (P=0.04), Timo W. Hakkarainen, MD, of the University of Washington Medical Center, Seattle, and colleagues reported online in JAMA Surgery.

The database included 13,082 bariatric or colorectal surgery patients at 47 hospitals participating in Washington’s statewide Surgical Care and Outcomes Assessment Program.

But the association between anastomotic leaks within 90 days of surgery and NSAIDs — used by 24% of the patients — was only significant in the nonelective colorectal surgery group.

In that group, the odds of a leak were 70% higher with NSAID use (rate 12.3% versus 8.3% without NSAID use, P=0.01).

The study considered only post-operative use of the anti-inflammatory drugs, without information on preexisting use for cardiovascular prevention.

As postoperative use of NSAIDs have risen with availability of IV formulations, there have been concerns raised by small studies that NSAIDs impair anastomotic healing in the GI tract, Hakkarainen and colleagues noted.

“The results of this large statewide cohort study show that, among patients undergoing nonelective colorectal resection, postoperative NSAID administration is associated with a significantly increased risk for anastomotic complications. Given that other analgesic regimens are effective and well tolerated, these data may be enough for some surgeons to alter practice patterns,” the study concluded.

Leak was defined by reoperation, rescue stoma, revision of an anastomosis, or percutaneous drainage of an abscess. Results were controlled for age, sex, procedure type (bariatric or colorectal), operative approach, protective ostomy, comorbid conditions, body mass index, a low serum albumin level, and other postoperative analgesic use.

Risk-adjusted 90-day mortality was similar between groups.

Limitations included lack of data on which NSAID was used, at what dose, or how long.

Further study is needed to determine if there’s a dose effect, what the mechanism might be, if it’s limited to certain formulations, and if overall recovery is affected, the group added.