eP560 - Minimally Invasive Surgery for Ulcerative Colitis: Trends and Surgical Outcomes

Purpose/Background: The medical management of patients with IBD has evolved immensely over the last decade. However, patients with refractory ulcerative colitis (UC) may still require surgical management of their disease. Minimally invasive surgical (MIS) techniques are increasingly utilized across all surgical disciplines, however trends of use in patients with UC as well as surgical outcomes of patients converted to open are understudied. The aims of this study were to characterize trends in the use of MIS for UC patients over the last decade, as well as compare outcomes of patients converted to open to planned open cases.Methods/Interventions: Patients who underwent surgery for UC were identified using the ACS-NSQIP database (2013-2021). Patients were stratified by operative approach (planned open, laparoscopic, or robotic). Utilization of different MIS surgical approaches (lap vs robotic) over the study period was investigated. Propensity score matching (PSM) based on demographic and surgical characteristics was utilized to compare the primary outcomes (30-day overall and serious morbidity) between planned open surgeries and laparoscopic cases converted to open.Results/Outcomes: A total of 3,978 patients underwent surgery for UC between 2013 and 2021. The majority of patients underwent an MIS approach (n=2,902, 73% lap, n=557, 14% robotic). A robotic approach was increasingly utilized during the study period (Figure). In 2013, a robotic approach accounted for 2.3% of MIS surgeries for UC, which increased to 34% in 2021. Despite increases in the utilization of the robotic platform, rates of conversion to open remained low with only 18 UC (3.2%) cases converted to open during the study period. When compared to patients who underwent a planned open procedure, patients who had a robotic surgery converted to open were more frequently obese (61% vs. 17%, p < 0.001), however operative stress scores and other patient demographics were similar between the two groups. Robotic patients who were converted to open had similar rates of overall morbidity when compared to planned open cases (44% vs 31%, p=0.243), however there were higher rates of serious morbidity (44% vs. 17%, p=0.002) driven by organ/space infections (28% vs. 10%, p=0.018), as well as increased rates of reoperation, and longer operative times (Table). Readmission rates, LOS, rates of ileus and anastomotic leak were similar between the two groups. For the laparoscopic group, after PSM (n=85), patients converted to open had similar baseline characteristics to planned open cases. Patients who underwent attempted laparoscopic surgery for UC but were converted to open (n=85) had similar rates of overall (38% vs. 32%, p=0.420) and serious morbidity (18% vs. 19%, p=0.843) compared to planned open UC cases (Table). However, patients converted to open did have lower rates of reoperation compared to the planned open group (2% vs 12%, p=0.032), and comparable LOS, readmission, ileus, and anastomotic leak rates.Conclusion/

Discussion: MIS surgery, particularly robotic surgery, for UC is increasing over the past decade. Outcomes between patients who underwent an attempted laparoscopic approach but were converted to open were similar, and in some cases improved, compared to the planned open group. However, robotic cases converted to open had higher rates of serious morbidity and reoperation. This research suggests that attempts should be made in most cases for an MIS approach in UC patients, and further research is needed to optimize patient selection for a robotic approach."Table.

Figure 1. Trends of MIS Approach in UC Patients
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