Clinical Corner - April 2024

The coding of specific operative approaches to cancer is extremely important in assessing outcomes after diverse operative approaches for the same cancer site. This is certainly true for the management of colon cancer.

Although both robotic and laparoscopic surgical approaches are considered minimally invasive and use small incisions and a camera to view the procedure, surgeons performing laparoscopy manually manipulate the tools and use a thin telescopic rod outfitted with a tiny two-dimensional laparoscope to view the surgical site, whereas surgeons performing robotic surgery have a control console to maneuver the robotic arms outfitted with surgical tools. The more advanced technology of robotic surgery not only may create a higher-quality three-dimensional view of the procedure but may also offer better precision and range of motion and eliminate any hand tremors by the surgeon.

In a recent retrospective study, investigators compared the outcomes achieved by robotic and laparoscopic procedures. Colorectal procedures were identified by location: right and left colectomies and low anterior resections. They found that 71% of the robotic procedures for right colectomies resulted in excellent outcomes compared with 64% of the laparoscopic treatments. The results were similar for left colectomies at 75% vs 68%, respectively. Further, the investigators discovered that the patients who had robotic surgery may have had shorter hospital stays, lower rates of complications, more lymph nodes harvested, more accurate cancer staging, fewer conversions to open surgery necessitated by anatomic challenges, and better return of bowel function. Only the patients receiving low anterior resection experienced better outcomes with laparoscopic surgery.

As newer operative approaches are introduced in the future, the capture of these operative approaches is mandatory for our registry abstracts.