Comparison of outcomes between robot-assisted and laparoscopic colorectal cancer surgery in patients with heart failure: A National Readmission Database analysis (Preprint)

BACKGROUND Patients with colorectal cancer (CRC) and comorbid heart failure (HF) have increased risk of adverse surgical outcomes. The outcomes of robotic-assisted and laparoscopic surgery for CRC in patients with HF have not been compared. OBJECTIVE This study aimed to compare the outcomes of these 2 methods for patients with CRC and HF. METHODS The Nationwide Readmissions Database from 2016 to 2020 was retrospectively reviewed for patients with CRC and HF who received robotic-assisted or laparoscopic surgery. Outcomes included in-hospital mortality, postoperative complications, prolonged length of hospital stay (LOS), and 30- and 90-day readmission rates. Univariate and multivariable logistic regression models were used to compare outcomes between robotic-assisted and laparoscopic surgery. RESULTS A total of 1,380 patients (mean age 74 years; 58% male) were included in the analysis. Multivariable analysis showed similar risks of prolonged LOS and 30-day and 90-day readmission rates between the 2 procedures. However, after adjusting for confounders robotic-assisted surgery was associated with a higher risk of acute kidney injury (AKI) (adjusted odds ratio [aOR] = 1.52, 95% confidence interval [CI]: 1.10-2.09, p = 0.01). Further analysis showed that male sex, pre-existing chronic kidney disease, and weekend admission were also independently associated with AKI. CONCLUSIONS Robotic-assisted surgery for CRC in patients with HF has a similar risk of prolonged LOS and readmission compared to laparoscopic surgery; however, it is associated with a higher risk of AKI. These findings emphasized the need of careful decision-making regarding surgical approaches for patients with HF and CRC.