Risk factor analysis of postoperative complications after robotic rectal cancer surgery

Background The robotic system has been adopted as the new modality for minimally invasive surgery for rectalcancer. However, analysis of risk factors for complicationsafter robotic rectal cancer surgery (RRS) has been limited.This study aimed to identify the risk factors for complicationsafter RRS.Methods The records of 389 consecutive patients whounderwent RRS between June 2006 and October 2010 wereretrieved from our prospectively collected database.Results The overall complication rate was 19%. The mostcommon complicationwas anastomotic leakage (7.0%),followed by voiding difficulty, intrapelvic abscess, andileus/obstruction. Multivariate analysis revealed the followingas risk factors for postoperative complications:male gender, history of previous abdominal surgery, andlower tumor level (hazard ratio [HR] = 1.8, 95% confidenceinterval [CI] = 1.0-3.1, p = 0.041; HR = 2.3; 95%CI = 1.2-4.6, p = 0.012; and HR = 1.9, 95% CI =1.1-3.3, p = 0.020, respectively). With regard to pelvicseptic complications, lower tumor level, large tumor size,and preoperative chemoradiation remained variables thatretained their statistical significance in multivariate analysis(HR = 2.6, 95% CI = 1.1-6.1, p = 0.029; HR = 2.7,95% CI = 1.1-6.1, p = 0.017; HR = 2.9, 95% CI =1.3-6.5, p = 0.007, respectively). The rate of postoperativecomplications was not influenced by the difference inlaparoscopic surgery experience or the technique of roboticsurgery. Conclusion Surgeons should be more cautious with thesepatient factors to optimize the benefits of robotic rectalresection.