Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study

Robotic surgery was introduced to overcome laparoscopic drawbacks. This study aimed to compare the learning curve of robotic-assisted right colectomy (RRC) versus laparoscopic-assisted right colectomy (LRC) for colon cancer with respect to operative times and perioperative outcomes. In addition, the health-related costs associated with both procedures were analyzed and compared. Between 2012 and 2015, 30 consecutive patients underwent RRC and 50 patients LRC for colon cancer. All procedures were performed by a surgical fellow novice in minimally invasive colorectal surgery. The operative time and the cumulative sum method were used to evaluate the learning curve of RRC versus LRC. The mean operative times were 200.5 minutes for RRC and 204.1 minutes for LRC (P = .408) and showed a significant decrease over consecutive procedures (P < .0001). The number of cases necessary to identify a drop in the operative time was 16 for RRC and 25 for LRC. RRC procedures were associated with significantly reduced blood loss (P = .012). Two patients (4%) in the LRC group were converted to laparotomy, whereas no conversion was required in the RRC group. Surgery-related costs were significantly more expensive for RRC, but when combined with the hospitalization-related costs, LRC and RRC did not differ (P = .632). Both robotic and laparoscopic operative times decrease rapidly with practice. However, RRC is associated with a faster learning curve than LRC. The simultaneous development of these two minimally invasive approaches appears to be safe and feasible with acceptable health-related costs.

AimThe aim of the study was to compare the short-term surgical outcomes of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC) for colon cancer, to evaluate the safety and feasibility of the robotic surgery system.Material and methodsA systematic literature review was conducted using the PubMed, Web of Science, Embase, and Cochrane Library databases regarding the comparison of RRC vs. LRC for colon cancer in the last 5 years. Studies were included as per the PICOS criteria, and relevant event data were extracted.ResultsFifteen studies (RRC: 1116 patients; LRC: 4036 patients) were evaluated. RRC demonstrated lower conversion to laparotomy (p = 0.03) and shorter length of hospital stay (p = 0.01), compared with LRC. However, operation times were longer in RRC than in LRC (p < 0.001). The estimated blood loss, retrieved lymph nodes, and overall postoperative complications were similar between RRC and LRC (p > 0.05).ConclusionsRRC can be regarded as a feasible and safe technique for colon cancer.

To minimize the parietal trauma associated with multiple surgical access sites, single-incision laparoscopic surgery for colectomy has been emerging with the improvements in instrumentation and surgical techniques. The purpose of this study was to compare the clinicopathological outcomes between single-incision laparoscopic right colectomy (SILC) and multiport laparoscopic right colectomy (MLC) for right colon cancer. Thirty-five consecutive patients undergoing SILC from a prospective single-institution database were case matched according to demographic data to an equivalent number of patients who underwent MLC. The SILC patients had decreased scores for maximal pain assessed by a visual analog scale on postoperative days 1 and 3, and used fewer postoperative systemic narcotics. The median length of the hospital stay for the SILC patients was significantly shorter compared with the MLC patients. The postoperative morbidity rates were similar between the groups. The oncological findings were not significantly different between the groups. SILC is a feasible and safe alternative to conventional MLC for patients with right colon cancer.

IntroductionRight-sided colon cancer is a prevalent malignancy. The standard surgical treatment for this condition is laparoscopic right hemicolectomy, with ileocolic anastomosis being a crucial step in the procedure. Recently, intracorporeal ileocolic anastomosis has garnered attention for its minimally invasive benefits. However, there remains a paucity of rigorously designed, large-scale, international multicenter randomized controlled trials to definitively assess the safety and efficacy of intracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for right-sided colon cancer.MethodsThis study is an international, multicenter, randomized, controlled, open-label, non-inferiority trial designed to compare the safety and efficacy of intracorporeal versus extracorporeal ileocolic anastomosis in patients with right-sided colon cancer undergoing right hemicolectomy. The primary endpoint is the anastomotic leakage rate within 30 days post-surgery. The main secondary endpoint is the 3-year disease-free survival rate post-surgery. A comprehensive quality assurance protocol will be established before the trial begins, including CT review, pathological evaluation, and the standardization and assessment of surgical techniques.DiscussionThis study aims to evaluate the safety and efficacy of intracorporeal ileocolic anastomosis following right hemicolectomy in patients with right-sided colon cancer. The anticipated outcome is that intracorporeal ileocolic anastomosis will show an anastomotic leakage rate and a 3-year disease-free survival rate comparable to those of extracorporeal anastomosis, while offering the added benefit of faster postoperative recovery.Graphical abstract

The National Surgical Quality Improvement Project (NSQIP) dataset was used to identify perioperative variables associated with the length of stay (LOS) and early discharge among cancer patients undergoing colectomy. Patients who underwent non-emergent right colectomy for colon cancer from 2012 to 2019 were identified from the NSQIP and colectomy-targeted databases. Postoperative LOS was analyzed based on postoperative day (POD) of discharge, with patients grouped into Early Discharge (POD 0–2), Standard Discharge (POD 3–5), or Late Discharge (POD ≥ 6) cohorts. Multivariable ordinal logistic regression was performed to identify risk factors associated with early discharge. The NSQIP query yielded 26,072 patients: 3684 (14%) in the Early Discharge, 13,414 (52%) in the Standard Discharge, and 8974 (34%) in the Late Discharge cohorts. The median LOS was 4.0 days (IQR: 3.0–7.0). Thirty-day readmission rates were 7% for Early Discharge, 8% for Standard Discharge, and 12% for Late Discharge. On multivariable regression analysis, risk factors significantly associated with a shorter LOS included independent functional status, minimally invasive approach, and absence of ostomy or additional bowel resection (all p < 0.001). Perioperative variables can be used to develop a model to identify patients eligible for early discharge after right colectomy for colon cancer. Efforts to decrease the overall median length of stay should focus on optimization of modifiable risk factors.

Robotic surgery has increased in recent years for the treatment of colorectal cancer; however, it is not yet the standard of care. This study aims to compare the 30-day outcomes after robotic colectomy for right-sided colon cancer from our institution with those from a national dataset, the targeted colectomy American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing elective, robotic, right colon resection for stage I, II, and III colon cancer were identified within the targeted colectomy ACS-NSQIP database from 2012 to 2014. Patients meeting the same criteria were identified within a prospectively maintained institutional database from 2009 to 2015. Univariate analyses using chi-square tests and Student's t-tests were done where appropriate to compare baseline characteristics and outcomes between the two groups. Patients at our institution had a significantly higher average number of lymph nodes retrieved (24.4 versus 20.1, P = .046). There was no statistically significant difference between the two groups regarding the incidence of wound infections, anastomotic leaks, blood transfusions, unplanned return to the operating room, or prolonged length of hospital stay. There were no 30-day mortalities at our institution and only one in the ACS-NSQIP database. Our institutional experience with robotic right colon resection is equivalent to that of a national sample. This study demonstrates the safety of performing robotic right hemicolectomy for the treatment of colon cancer.

There are still significant differences between Western and Eastern in terms of current guidelines for the criterion of lymphadenectomy in laparoscopic right colectomy for colon cancer. In recent years, with the proposal and improvement of complete mesocolic excision (CME) and the wide application of laparoscopic technique in colon cancer surgery, many colorectal specialists believe that laparoscopic CME surgery should become a standard operation for the right colon cancer. The CME principle plays critical role in the surgical approach and quality control of the right colectomy. Based on CME principle, anatomical level should always be kept during laparoscopic surgery, which ensured the radical resection of metastatic and disseminated enteric mesenteric membrane, as well as regional lymph nodes. Such excision and lymph node dissection did not significantly increase the complications related to the operation, and could improve postoperative survival. However, due to the limitation of retrospective studies, its advantages of surgical safety and oncology benefit are unconvincing. The findings of high level evidence-based medical evidence are still needed in the future. Key words: Colonic Neoplasms; Laparoscopy; Lymph Node Excision

Background: Laparoscopic right colectomy (LRHC) is a procedure which has been getting more popular compared to traditional open right colectomy (ORHC) over the last three decades. This study compares the post-operative outcomes in laparoscopic and open right colectomy for colon cancer.&#x0D; Patients and Methods: This is a retrospective study of right colectomy at a single institution from January 2018 to December 2021. The factors that were studied included postoperative HDU admission, the incidence of post-operative ileus (POI) and the length of hospital stay.&#x0D; Results: During the study period, 161 patients underwent right hemicolectomy. Sixty-seven (42%) underwent LRHC, 73 (45%) ORHC, and 21 (13%) laparoscopic converted to open procedure. The overall incidence of POI was 56 (35%), 14 (21%) among the LRHC and 28 (38%) among the ORHC group (p=0.024). The length of hospital stay was 7.1 (±4.8) days after the laparoscopic procedure compared to 8.7 (±4.4) in the open group (p=0.048). Forty-two patients out of 161 (26%) needed post-operative HDU admissions; out of these 11 (16%) were in the laparoscopic group and 29 (40%) among the open group (p=0.023).&#x0D; Conclusion: Post-operative recovery was significantly quicker among the laparoscopic right hemicolectomy group incomparison to the open right hemicolectomy group.

The principle of complete mesenteric excision (CME) has been applied in colon cancer surgery for ten years. The concept of CME emphasized embryological anatomical complete resection of mesocolon, dissection of the central lymph nodes and high ligation of feeding vessels However, in the subsequent clinical application and promotion, it was found that the principle has not been accurately defined in many aspects, such as the boundary of the central lymph node dissection and the length of the bowel resection in the right colectomy for colon cancer. The quality control standards for CME procedure has also been clarified in the process of continuous practice. This article reviews the definition of extended laparoscopic resection of right colon cancer and the principles of CME operation, and discusses the evaluation criteria of extended laparoscopic resection of right colon cancer. Key words: Colonic neoplasms; Mesocolon; Laparoscopy; Complete mesocolic excision

As laparoscopic surgery is applied to colorectal surgery procedures, it becomes imperative to delineate whether there is an operative duration where benefits diminish. The purpose of this work was to determine whether benefits of a laparoscopic right colectomy compared with an open right colectomy are diminished by prolonged operative times. We performed a retrospective analysis comparing outcomes of patients undergoing laparoscopic right and open right colectomy for colon cancer with operative duration of less than and greater than 3 hours. This study was based on data in the American College of Surgeons National Surgical Quality Improvement Program database. We queried the database for patients with laparoscopic and open right colectomy with a diagnosis of colorectal cancer between 2005 and 2010. Patients were stratified by operative technique and duration. Forward multivariable logistic regression analysis was performed for mortality, cerebrovascular/cardiovascular complications, and infectious complications. Predictors of operative time >3 hours in the laparoscopic cohort were identified by logistic regression. Of 4273 patients, operative duration was >3 hours for 18.4% of patients with a laparoscopic right colectomy and 11.3% with an open right colectomy. There was no benefit of the laparoscopic right colectomy with an operative duration >3 hours over open right colectomy with respect to mortality and cardiopulmonary and cerebrovascular complications. An operative duration >3 hours was an independent risk factor for infectious complications in patients undergoing a laparoscopic right colectomy. This was a retrospective study and not an intention-to-treat analysis. At an operative duration of ≥3 hours, laparoscopic right colectomy has higher infectious complications than open right colectomy. Reduced mortality and less cardiopulmonary and cerebrovascular complications seen in the laparoscopic cohort with shorter operative duration were lost with an operative duration >3 hours. In patients at risk for prolonged laparoscopic right colectomy, early conversion to an open technique may be warranted.

Single-incision robotic surgery (SIRS) using the da Vinci SP system (dVSP) offers advantages such as improved cosmesis, reduced invasiveness, and technical precision in colorectal surgery. However, real-world data regarding the technical feasibility and oncologic outcomes of dVSP-based complete mesocolic excision (CME) with central vascular ligation (CVL) for right-sided colon neoplasms remain limited. We retrospectively reviewed the medical records of patients who underwent single-incision robotic right colectomy for colon cancer or precancerous lesions with dVSP between July 2019 and April 2025. Demographic characteristics, perioperative outcomes, pathologic results, and survival outcomes were analyzed. Fifty-two patients were included. Mean operation time and estimated blood loss were 282.2 ± 54.5min and 65.9 ± 44.9ml, respectively. Intracorporeal anastomosis was performed in 67.3% of cases, and the mean umbilical wound length was 3.7 ± 0.9cm. There were no conversions to open surgery or intraoperative complications. The mean time to first flatus was 2.6 ± 0.7days, and patients began a soft diet at 3.2 ± 0.6days postoperatively, with a mean hospital stay of 7.0 ± 2.4days. Postoperative complications occurred in 19.2% and readmission rate was 5.8%. Pathologic outcomes showed 23.9% of patients with stage III disease, the mean number of harvested lymph nodes was 45.5 ± 25.0, and all cases had negative resection margins. One patient (1.9%) developed local recurrence at 8months postoperatively, resulting in disease-specific mortality, and another patient (1.9%) developed multiple lung metastases at 9months and is currently receiving palliative chemotherapy. Among patients with malignant tumors, 5-year overall survival and disease-free survival rates were 93.3% and 93.7%, respectively. The median follow-up period was 30.0 (range 5.0-72.0) months. Single-incision robotic right colectomy using the dVSP is technically feasible and safe approach, offering favorable perioperative results and has proven oncologic safety based on long-term outcomes.

Accordion complication grading predicts short-term outcome after right colectomy

Several techniques are described in the literature about laparoscopic treatment of the right colon. Among them, laparoscopic-assisted colectomy (LAC) with creation of an extracorporeal ileocolonic anastomosis remains the favourite approach in most centers. So far, total laparoscopic colectomy (TLC) with intracorporeal anastomosis is not widely performed, because it requires adequate skills and competence in the use of mechanical linear staplers and laparoscopic manual sutures. The purpose of this study was to determine prospectively if TLC offers some advantages in short-term outcomes over LAC. A prospective comparative study was designed for 80 consecutive patients who were alternatively treated with TLC and LAC for right colon neoplasms. The following data were collected: operative time, intra- and postoperative complication rate, time to bowel movement, hospitalization time, length of minilaparotomy, number of harvested lymph nodes, and specimen length. Operative time in TLC resulted significantly longer than in LAC (230 vs. 203 min), complication rate was similar in both groups, with no case of anastomotic dehiscence, two anastomotic bleedings in TLC vs. three in LAC and one case of postoperative ileus for each group. One case of death occurred in LAC patient developing a postoperative severe cardiopulmonary syndrome. Time to first flatus was in favour of TLC (2.2 vs. 2.6 days), whereas hospitalization was comparable. As regards to the oncological parameters of radicality, the specimen length was superior in TLC group, but the number of lymph nodes excised was equivalent. The length of the minilaparotomy was clearly shorter in TLC group (5.5 vs. 7.2 cm). No evidence of relevant differences in terms of functional and safety outcomes between the two laparoscopic procedures. TLC determines less abdominal manipulation and shorter incision length, but clear advantages must be still demonstrated. Larger series are necessary to test the superiority of totally laparoscopic procedures for right colectomy.

To assess whether full bowel preparation affects 30-day surgical outcomes in laparoscopic right colectomy for colon cancer. A retrospective chart review of all elective laparoscopic right colectomies performed for colonic adenocarcinoma between Jan 2011 and Dec 2021. The cohort was divided into two groups-no bowel preparation (NP) group and patients who received full bowel preparation (FP), including oral and mechanical cathartic bowel preparation. All anastomoses were extracorporeal stapled side-to-side. The two groups were compared at baseline and then were matched using propensity score based on demographic and clinical parameters. The primary outcome was 30-day postoperative complication rate, mainly anastomotic leak (AL) and surgical site infection (SSI) rate. The original cohort included 238 patients with a median age of 68 (SD 13) and equal M:F ratio. Following propensity score matching, 93 matched patients were included in each group. Analysis of the matched cohort showed a significantly higher overall complication rate in the FP group (28 vs 11.8%, p = 0.005) which was mostly due to minor type II complications. There were no differences in major complication rates, SSI, ileus, or AL rate. Although operative time was significantly longer in the FP group (119 vs 100min, p ≤ 0.001), length of stay was significantly shorter in the FP group (5 vs 6days, p = 0.001). Aside from a shorter hospital stay, full mechanical bowel preparation for laparoscopic right colectomy does not seem to have any benefit and may be associated with a higher overall complication rate.

Anastomotic leak (AL) is the most severe complication after laparoscopic right colectomy (RC), with historical median rates around 8%. Whether intracorporeal ileocolic anastomosis (ICA) offers advantages over extracorporeal anastomosis (ECA) under standardized, purely laparoscopic conditions remains uncertain. We aimed to compare AL rates and short-term postoperative outcomes between ICA and ECA in laparoscopic RC for colon cancer. Prospective multicenter cohort (TREND-compliant) across 11 hospitals (January 2019-June 2022). Adults with non-metastatic right colon cancer undergoing elective laparoscopic RC were included. Exposure (ICA vs ECA) was determined by each hospital's routine practice. AL, per predefined clinical, radiologic, or endoscopic criteria. conversion to open surgery, length of stay (LOS), complications (Clavien-Dindo), surgical site infection (SSI), and a composite of severe complications (COSC). Analyses used the full cohort; propensity score matching (PSM) was prespecified as a sensitivity analysis. A total of 438 patients were analyzed: 225 ICA and 213 ECA. AL occurred in 3/225 (1.33%) after ICA and 3/213 (1.41%) after ECA (p = 1.00; risk difference - 0.08 percentage points; 95% CI - 2.1 to 2.3). Conversion was lower with ICA (2.2% vs 7.5%; p = 0.013), while LOS was shorter with ICA (median 4days; p < 0.001). There were no significant differences in severe morbidity (Clavien-Dindo ≥ III: 5.8% ICA vs 3.8% ECA; p = 0.375), SSI (incisional or organ/space), COSC (6.7% ICA vs 4.2% ECA; p = 0.298), reoperation, or mortality. Findings were consistent in PSM analyses (213:213). In this prospective multicenter laparoscopic cohort, both intracorporeal and extracorporeal anastomosis achieved anastomotic-leak rates below 2%, with no superiority of one technique over the other regarding leak or severe morbidity. ICA was associated with lower conversion and shorter hospital stay. These results confirm the overall safety and feasibility of both approaches in experienced centers. NCT03918369.