eP277 - Robotic versus Laparoscopic Colorectal Surgery for Patients with Obesity: An Updated Systematic Review and Meta-Analysis

Purpose/Background: A systematic review and meta-analysis was published in 2019 by Wee et al. that pooled data comparing robotic and laparoscopic approaches to colorectal surgery for patients with obesity. Three studies were included in their synthesis and findings suggested robotic surgery contributed to decreased postoperative length of stay (LOS) and reduced readmissions but was also associated with increased operative time. Since this review, there have been other large observational cohort studies published. As such, we designed the present systematic review and meta-analysis to update the previous evidence synthesis and compare robotic laparoscopic approaches for patients with obesity undergoing colorectal surgery.Methods/Interventions: This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search in MEDLINE, Embase, and CENTRAL from database inception to August 2023 was performed. Articles were eligible for inclusion if they were randomized controlled trials or observational cohort studies comparing robotic and laparoscopic approaches to colorectal surgery for patients with obesity (i.e., body mass index greater than 30 kg/m2). The main outcomes included operative time, conversion to laparotomy, overall morbidity, surgical site infection (SSI), anastomotic leak, readmission, and postoperative LOS. A pair-wise meta-analysis was performed using an inverse variance random effects model. Risk of bias was assessed with Cochrane risk of bias tools. The GRADE approach was conducted to assess quality of evidence.Results/Outcomes: After reviewing 2,187 relevant citations, 10 observational studies met inclusion criteria. Overall, 3,331 patients with obesity (mean age: 58.111.3, 43.0% female) underwent robotic surgery and 10,846 patients (mean age: 58.012.3, 51.3% female) underwent laparoscopic surgery. Most operations were performed for colorectal cancer (70.6%). In the robotic group, 41.8% and 58.2% underwent colectomy and proctectomy, respectively. In the laparoscopic group, 61.4% and 38.6% underwent colectomy and proctectomy, respectively. Across seven studies, operative time was 43.90 minutes longer in the robotic surgery group (95%CI 27.49-60.31, p < 0.00001, I2=96%). Across eight studies, the risk of conversion to laparotomy was 44% lower in the robotic surgery group (RR 0.56, 95%CI 0.45-0.70, p < 0.00001, I2=53%). There were no significant differences in overall morbidity (two studies, RR 0.98, 95%CI 0.84-1.14, p=0.82, I2=52%), SSI (three studies, RR 1.03, 95%CI 0.74-1.44, p=0.85, I2=0%), anastomotic leak (four studies, RR 1.30, 95%CI 0.84-1.99, p=0.24, I2=0%), nor readmission (RR 0.96, 95%CI 0.74-1.26, p=0.78, I2=42%), nor postoperative LOS (five studies, MD -0.24, 95%CI -0.59-0.10, p=0.16, I2=67%). Risk of bias was moderate-to-serious for all included studies. GRADE certainty of evidence was very low for all outcomes.Conclusion/

Discussion: Very low certainty evidence suggests that patients with obesity undergoing colorectal surgery likely experience a reduction in the risk of conversion to laparotomy when undergoing robotic surgery as compared to laparoscopic surgery. This is at the expense of increased operative time. There are no clinically meaningful differences in other perioperative outcomes between robotic and laparoscopic surgery for this patient population.