Impact of Minimally Invasive Approach on Attainment of a Textbook Oncologic Outcome Following Colectomy for Colon Cancer-A Review of the National Cancer Database

Purpose Textbook oncologic outcome is a composite measure achieved when all desired short-term quality metrics are met following an oncologic operation. This study aimed to determine the impact of surgical approach on textbook oncologic outcome achievement after colectomy for colon cancer. Methods We queried the 2010-2017 National Cancer Database for patients with non-metastatic colon cancer who underwent colectomy, then stratified them by surgical approach: open colectomy vs laparoscopic colectomy vs robotic colectomy. Textbook oncologic outcome was defined by six metrics: resection with negative margins (R0), adequate lymphadenectomy (≥ 12), no prolonged length of stay (< 50th percentile by year), no 30-day readmission, no 30-day mortality, and timely initiation of adjuvant chemotherapy (≤ 12 weeks). Surgical approaches were categorized as open, laparoscopic, and robotic colectomy. Results The open group had the lowest textbook oncologic outcome attainment (open = 27.7%, LC = 45%, RC = 41.9%) and also performed poorly on five of the six TOO criteria: R0 resection (94.4%), adequate lymphadenectomy (88.3%), minimal length of stay (41.0%), no 30-day readmission (92.1%), and timely adjuvant chemotherapy (86.3%). Multivariate logistic regression suggested that laparoscopic colectomy (AOR = 2.04; p < 0.001) and robotic colectomy (AOR = 1.69; p < 0.001) were associated with increased likelihood of textbook oncologic outcome attainment. Conclusions Achieving TOO is a crucial predictor of long-term survival across all surgical approaches for colon cancer. Our findings suggest that a robotic surgical approach may offer significant advantages in attaining TOO following colectomy.