Does prolonged operative time impact postoperative morbidity in patients undergoing robotic-assisted rectal resection for cancer?

Background: Several studies have shown a correlation between longer operative times and higher rates of postoperative morbidity for open and laparoscopic surgery for rectal cancer. The aim of the study was to determine the impact of prolonged operative time on early postoperative morbidity in patients undergoing robotic-assisted rectal cancer resection. Methods: The study was a retrospective review of a prospectively maintained database conducted in two centers of the same institution. A total of 260 consecutive patients undergoing with robotic-assisted resection for rectal cancer between 2007 and 2016 were included. Patients were divided into two groups regarding median operative time: > 300 min (prolonged operative time; n = 133) and ≤ 300 min (control; n = 127). Patient characteristics, operative and postoperative data were compared between groups. Univariate and multivariate analyses were performed to determine whether prolonged operative time was a predictive factor of 30-day postoperative morbidity. Results: Prolonged operative time was noted more frequently in males (p = 0.02), patients with higher BMI (p < 0.01), more severe comorbidities (p < 0.01), in tumors of the mid-rectum, and in surgery performed after neoadjuvant chemoradiation or upon surgeons’ learning curve. The two groups had similar overall postoperative morbidity (32 vs. 41%; p = 0.16) and severe morbidity (6 vs. 6%; p = 0.92) rates. Prolonged operative time was associated with longer hospital stay (3.8 ± 2.5 vs. 5.0 ± 3.7 days; p = 0.004) in univariate analysis. Prolonged operative time was not independently associated with postoperative morbidity or with increased hospital stay on multivariate analysis. Conclusion: In our study, prolonged operative time was not associated with an over-risk of morbidity in patients undergoing robotic resection for rectal cancer. These results suggest that more difficult robotic procedures do not lead to increased postoperative morbidity.