Surgical stress response and long-term survival in robot-assisted versus laparoscopic surgery for colon cancer: a propensity matched nationwide cohort study

PURPOSE: This study investigates the potential correlation between the surgical stress response and long-term survival in patients undergoing treatment for colon cancer using either RAS (robot-assisted surgery) or LAS (laparoscopic surgery) and whether this correlation is influenced by the surgical approach. The primary objective was to assess the association between postoperative C-reactive protein (CRP) response and recurrence-free survival in RAS compared with LAS. Secondary endpoints included all-cause mortality and time-to-recurrence.

METHODS: This Danish nationwide cohort study included patients diagnosed with Union for International Cancer Control (UICC) stage I-III colon cancer who underwent either RAS or LAS between 2010 and 2018. We employed the Cox proportional regression model to analyze the time-to-event outcomes for both primary and secondary endpoints in patients exhibiting either a low postoperative CRP response (< 80 mg/L) or a high CRP response (CRP ≥ 80 mg/L).

RESULTS: A total of 3484 patients were included in the study, with 490 (14.1%) undergoing RAS and 2994 (85.9%) undergoing LAS. The median follow-up time was 32.5 months (interquartile range [IQR] = 21.0-48.7) for the RAS group and 35.4 months (IQR = 22.8-50.9) for the LAS group. In the RAS group, a lower CRP response (CRP < 80 mg/L) was not associated with improved recurrence-free survival (HR = 0.78, 95% confidence interval [CI] [0.53-1.13], p = 0.184), all-cause mortality (hazard ratio [HR] = 0.76, 95% CI [0.46-1.26], p = 0.282), or time-to-recurrence (HR = 0.64, 95% CI [0.49-1.06], p = 0.079).

CONCLUSIONS: The postoperative CRP response was not significantly associated with improved long-term survival outcomes in patients undergoing RAS or LAS for UICC stage I-III colon cancer.