SP5.7 - Identifying patients for safe early discharge following robotic colorectal resection: can C reactive protein levels help?

Abstract Aims Current enhanced recovery protocols are mainly based on outcomes from laparoscopic surgery and do not factor in the reduced stress response seen in robotic surgery. We report our centre’s seven-year experience in managing patients undergoing robotic colorectal resections and aim to define cut-offs for inflammatory markers to allow early and safe discharge of these patients. Methods A retrospective single-centre UK study including patients who underwent robotic colorectal resections with primary anastomosis from 01/02/2015 to 28/02/2022. Serial white cell counts and C-reactive protein (CRP) levels from postoperative day 1 to 5 were used as surrogate markers for assessing inflammatory response. Anastomotic leak was defined as evidence of disruption on imaging or on direct visualisation at return to theatre. Results In total, 200 patients were included based on our inclusion criteria. Overall, 19 patients (9.5%) had anastomotic leaks postoperatively. Postoperatively, a higher day 3, 4, and 5 white cell count and CRP were seen in patients with anastomotic leak. ROC curve analysis revealed a day 3 CRP of < 95.5 mg/L had a sensitivity of 94.4% in predicting no anastomotic leak with an AUC of 0.842. In our study, 94/200 patients met this cut-off and could have been safely discharged from hospital at day 3. Conclusion A day 3 CRP of < 95.5 mg/L was found to be a sensitive marker in ruling out anastomotic leak in patients undergoing robotic colorectal resection which is lower than the threshold described in the literature for open/laparoscopic procedures. Enhanced recovery protocols need to be redesigned to factor in the relative reduction in inflammatory response conferred by robotic surgery.