EP280 - Initial Clinical Outcomes of Colorectal Resections Following a Newly-Introduced Robotic-Assisted Service: A Single-Centre Experience of the Learning Curve

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Purpose/Background: Robotic-assisted surgery has become popular in General Surgery due to its minimally invasive approach, precision and predictability. This aims to enhance short-term postoperative recovery and long-term patient outcomes. In our local hospital, robot-assisted surgery was introduced for colorectal cancer resections, and adapting to the new service became a focal point for stakeholders and patients. Therefore, we wanted to evaluate the learning curve faced by our general surgeons in using robotic platforms for colorectal cancer resections and the impact this had on patient outcomes during this initial learning and adaptation phase.

Methods/Interventions: This study was performed in accordance with STROBE guidelines. Data records were retrieved from our departmental colorectal cancer multi-disciplinary team (MDT) database. Robotic-assisted procedures were introduced in April 2023. Thus, a retrospective analysis was performed on a cohort of patients undergoing robotic colorectal resections from inception until August 2024. Data was collected from patients operated by two independent colorectal surgeons who undertook robotic-assisted surgery training. Patient demographics, American Society of Anaesthesiologists (ASA) grade, Charlston-Comorbidity Index (CCI), and intraoperative and postoperative outcomes were collected. Our primary outcome was intraoperative duration, surgical resection margin, and the sample of positive lymph nodes. Secondary outcomes included length of stay (LOS) and Morbidity (Clavien-Dindo (CD) Classification). Frequency statistics and bivariate correlation between variables were performed using Spearman's Rank Test in SPSS (IBM).

Results/Outcomes: 51 patients were identified; 72.5% (n=37) were male, and the mean cohort age was 69 years (±11.1). CCI scores ranged between 2 - 10, and 72.5% (n=37) had an ASA grade of 3 or more. The average operative time was 261 minutes (range 90 - 540), with 23.5% of cases (n=12) completed in less than 180 minutes. 72.5% (n=37) had a surgical resection margin distance to the tumour reported on histology; median 31.5mm (range 0.2mm - 1cm). Positive node was reported in 34.6% (n=18). No patient deaths were reported within the data collection period. Clavien-Didno III complications were reported in 5% (n=3). 3.9% (n=2) required conversion to either conventional laparoscopy or open. The median length of stay was five days (range 3 - 44). There was no significant correlation between the primary or secondary outcomes and the number of months the robotic-assisted service was used. No significant correlation was observed between operative duration and resection margin, number of lymph nodes sampled, positive lymph nodes or length of stay.

Conclusion/Discussion: After introducing a new service, the learning curve of robotic-assisted surgery by two independent, established general surgeons was not associated with an obvious positive or negative impact on intraoperative or postoperative outcomes. The variation in data and outcomes is likely secondary to the surgeon's experience and the patient's pre-operative state. Robust trials should be conducted to evaluate technical skills, identify areas and offer opportunities for better surgeon education and patient outcomes.