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Background <p>Robotic surgery is increasingly used to treat ileocolic Crohn’s disease (CD). However, there is scant data on postoperative recurrence following robotic primary ileocolonic resection (RICR) when compared to laparoscopic primary ileocolonic resection (LICR).</p> Methods <p>All consecutive adult patients who underwent RICR or LICR for CD between January 2016 and November 2024 and endoscopic follow-up at our institution were included in this study. The primary outcome was endoscopic recurrence (ER). Secondary outcomes included postoperative morbidity, clinical recurrence (CR), and surgical recurrence (SR).</p> Results <p>A total of 314 patients were included in the study (82 with RICR vs. 232 with LICR). RICR was significantly associated with a higher rate of iso-peristaltic side-to-side anastomoses (68.3% vs. 21.6% in LICR, <i>p</i> &lt; 0.001), while anti-peristaltic side-to-side anastomoses were prevalent in LICR with the same proportion. After a median follow-up of 11.5 (6.6,&#xa0;28.5) months, 115 of 314 patients developed ER. Both 1-year and 3-year ER-free survival rates were similar (71.8% vs. 73.0% and 51.4% vs. 55.9% for RICR and LICR, respectively; <i>p</i> = 0.82). After a median clinical follow-up of 37.6 (2.2, 111.5) months, no significant differences were observed between RICR and LICR in either cumulative CR (20.7% vs 27.2%, <i>p</i> = 0.3) or SR (3.7% vs. 0.9%, <i>p</i> = 0.11). Robotic iso-peristaltic anastomosis demonstrated similar postoperative morbidity, ER, CR, and SR rates when compared to both laparoscopic anti-peristaltic and iso-peristaltic configurations. Multivariable Cox regression analysis identified conversion to open approach (Hazard Ratio (HR): 1.8, <i>p</i> = 0.03) and lack of postoperative prophylaxis (HR: 0.6, <i>p</i> = 0.01) as independent risk factors associated with ER.</p> Conclusions <p>Robotic ICR for CD is an effective approach with disease recurrence rates comparable to those of laparoscopic surgery in long-term outcomes. The specific anastomotic configuration should be left at the discretion of the operating surgeon.</p>

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Comparative anastomotic configurations and disease recurrence rates of robotic vs. laparoscopic primary ileocolonic resection for Crohn’s disease

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • R. Liu,
  • L. Stocchi,
  • R. Sassun,
  • K. T. Behm,
  • D. W. Larson,
  • D. T. Colibaseanu,
  • M. F. DeLeon,
  • A. Merchea,
  • S. F. Shawki

摘要

Background

Robotic surgery is increasingly used to treat ileocolic Crohn’s disease (CD). However, there is scant data on postoperative recurrence following robotic primary ileocolonic resection (RICR) when compared to laparoscopic primary ileocolonic resection (LICR).

Methods

All consecutive adult patients who underwent RICR or LICR for CD between January 2016 and November 2024 and endoscopic follow-up at our institution were included in this study. The primary outcome was endoscopic recurrence (ER). Secondary outcomes included postoperative morbidity, clinical recurrence (CR), and surgical recurrence (SR).

Results

A total of 314 patients were included in the study (82 with RICR vs. 232 with LICR). RICR was significantly associated with a higher rate of iso-peristaltic side-to-side anastomoses (68.3% vs. 21.6% in LICR, p < 0.001), while anti-peristaltic side-to-side anastomoses were prevalent in LICR with the same proportion. After a median follow-up of 11.5 (6.6, 28.5) months, 115 of 314 patients developed ER. Both 1-year and 3-year ER-free survival rates were similar (71.8% vs. 73.0% and 51.4% vs. 55.9% for RICR and LICR, respectively; p = 0.82). After a median clinical follow-up of 37.6 (2.2, 111.5) months, no significant differences were observed between RICR and LICR in either cumulative CR (20.7% vs 27.2%, p = 0.3) or SR (3.7% vs. 0.9%, p = 0.11). Robotic iso-peristaltic anastomosis demonstrated similar postoperative morbidity, ER, CR, and SR rates when compared to both laparoscopic anti-peristaltic and iso-peristaltic configurations. Multivariable Cox regression analysis identified conversion to open approach (Hazard Ratio (HR): 1.8, p = 0.03) and lack of postoperative prophylaxis (HR: 0.6, p = 0.01) as independent risk factors associated with ER.

Conclusions

Robotic ICR for CD is an effective approach with disease recurrence rates comparable to those of laparoscopic surgery in long-term outcomes. The specific anastomotic configuration should be left at the discretion of the operating surgeon.