Preprint,
Surgical stress response and long-term survival in robot-assisted versus laparoscopic surgery for colon cancer: a propensity matched nationwide cohort study
Contributors
Cuk, Pedja
0000-0003-0582-604X
[1]
Rosen, Andreas Weinberger
0000-0001-9990-8155
[2]
Ellebæk, Mark Bremholm Bremholm
0000-0001-6550-7505
[1]
Gögenur, Ismail
0000-0002-3753-268X
[2]
Affiliations
- [1] University of Southern Denmark [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD];
- [2] Zealand University Hospital [NORA names: Region Zealand; Hospital; Denmark; Europe, EU; Nordic; OECD]
Abstract
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 CRP response and recurrence-free survival in RAS compared to LAS. Secondary endpoints included all-cause mortality and time-to-recurrence.
Methods
This Danish nationwide cohort study included patients diagnosed with 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 3,484 patients were included in the study, with 490 (14.1%) undergoing RAS and 2,994 (85.9%) undergoing LAS. The median follow-up time was 32.5 months (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% CI [0.53-1.13], p = 0.184), all-cause mortality (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).
Conclusion
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.
