Comparative analysis of postoperative inflammation and pain: robot-assisted versus single-incision laparoscopic surgery for right-sided colon cancer

Abstract

BACKGROUND: In recent years, surgical approaches for treating colorectal cancer have shifted from open surgery to laparoscopic surgery and, more recently, to robot-assisted surgery (RAS), yet their relative impact on postoperative inflammation and pain remains unclear. Therefore, this study aimed to compare the postoperative C-reactive protein/albumin ratio (CRA) and Numerical Rating Scale (NRS) scores between RAS and single-incision laparoscopic surgery (SILS) for right-sided colon cancer to assess which surgical modality might be more minimally invasive. METHODS: We retrospectively analyzed 180 patients who underwent surgical resection for right-sided colon cancer at Saitama Medical University International Medical Center (Hidaka, Saitama, Japan) between March 2021 and October 2024. Among these patients, 80 underwent RAS (RAS group) and 100 underwent SILS (SILS group). Propensity score matching (PSM) was applied, and 67 patients from each group were selected for comparison. Primary outcomes were the CRA and pain intensity on the NRS on postoperative days (POD) 1 and 3. Secondary outcomes included operative time, blood loss, and major complications (Clavien-Dindo > II). RESULTS: After PSM, there were no significant differences in the patient background variables, including the preoperative CRA, between the groups. The operative time was significantly shorter in the SILS group than in the RAS group (SILS vs. RAS: 157 vs. 193 min, p < 0.001). Although the CRA did not differ on POD 1 and 3, the SILS group had a significantly higher CRA than the RAS group. The RAS group had a significantly lower NRS score on POD 1. CONCLUSION: For right-sided colon cancer surgery, SILS involves fewer and smaller incisions and a shorter operative time. However, RAS was associated with a lower early postoperative inflammatory response and pain in this PSM comparison. The refined precision and reduced tissue manipulation offered by robotic systems may explain these differences.