Abstract
BACKGROUND: Minimally invasive surgical approaches, including laparoscopic and robotic techniques, improved outcomes in colorectal cancer resection by decreasing pain, hospital length of stay, and perioperative mortality. However, broader robotic adoption faces several barriers. This study evaluated national trends in robotic colorectal surgery using the National Cancer Database (NCDB). METHODS: Patients with stage I-III colon and rectal adenocarcinoma undergoing resection (2010 - 2021) were identified. Trends in surgical approach (open, laparoscopic, robotic) were analyzed. Multivariable logistic regression identified factors associated with robotic adoption. RESULTS: A total of 537,627 colon and 116,763 rectal resections were included. Robotics were utilized in 61,640 (11.5%) colon and 30,569 (26.1%) rectal cases. For colon cancer, robotic adoption increased +2.4% annually, nearly equalling open surgery by 2021 (26.7% vs. 27.2%). For rectal cancer, adoption rose +4.28% annually, surpassing both laparoscopic and open approaches by 2018. Robotic surgery was predominately performed in metropolitan centers (87.2%) versus rural areas (1.5%). Regionally, adoption was highest in the West North Central (+5.0%/year) and West South Central (+3.3%/year) regions and lowest in New England (+1.3%/year). Compared with New England, all regions were more likely to utilize robotics, with the West North Central region demonstrating the highest odds (OR 2.15; 95% CI: 1.95-2.38). CONCLUSIONS: Robotic colorectal cancer surgery has expanded substantially over the past decade, with marked regional and institutional disparities. Understanding these patterns may inform targeted educational initiatives and promote nationwide equitable adoption of robotic surgery.