Abstract
BackgroundRobotic surgery for transverse colon cancer has rarely been described. This study reports our initial experience in robotic resection for transverse colon cancer, by comparing robotic transverse colectomy (RC) to laparoscopic transverse colectomy (LC) in terms of safety, feasibility, short-term outcomes, and the surgeon’s psychological stress and physical pain.MethodsThe study population included the first 22 consecutive patients who underwent RC between March 2013 and December 2014 for histologically confirmed transverse colon adenocarcinoma. These patients were compared with 22 matched patients undergoing LC between December 2010 and February 2013. Patients were matched based on age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) score, American Joint Committee on Cancer (AJCC) tumor stage, and tumor location (ratio 1:1). Mortality, morbidity, operative, and short-term oncologic outcomes were compared between groups. The operating surgeon’s stress and pain were assessed before and after surgery on a 0–100-mm visual analog scale.ResultsThe demographic and preoperative characteristics were comparable between RC and LC patients. No group difference was observed for intraoperative complications, blood loss, postoperative pain, time to flatus, time to regular diet, and hospital stay. RC was associated with longer operative time than LC (260 min vs. 225 min; p = 0.014), but the overall operative and robotic time in the RC group decreased over time reflecting the increasing experience in performing this procedure. No conversion to laparotomy was observed in the RC group, while two LC patients were converted due to uncontrolled bleeding and technically difficult middle colic pedicle dissection. Postoperative complications (Dindo-Clavien grade I or II) occurred in 11.3 % of patients with no group difference. Mortality was nil. All resections were R0, with >12 lymph nodes harvested in 90.9 % of RC and 95.5 % of LC patients. The surgeon’s stress was not different between RC and LC, whereas the surgeon’s hand and neck/shoulder pain were significantly lower after RC.ConclusionsRC for transverse colon cancer appears to be safe and feasible with short-term outcomes comparable to LC.
Highlights
Robotic surgery for transverse colon cancer has rarely been described
A recent systematic review showed that robotic colorectal surgery is a safe and feasible option associated with similar outcomes in terms of oncologic results compared to laparoscopic or open surgery [1, 6]
Surgical outcomes Out of 382 colorectal procedures performed between December 2010 and December 2014, 22 consecutive patients who underwent robotic transverse colectomy (RC) were compared with 22 matched patients who underwent laparoscopic transverse colectomy (LC)
Summary
Robotic surgery for transverse colon cancer has rarely been described. This study reports our initial experience in robotic resection for transverse colon cancer, by comparing robotic transverse colectomy (RC) to laparoscopic transverse colectomy (LC) in terms of safety, feasibility, short-term outcomes, and the surgeon’s psychological stress and physical pain. Most authors reported a longer operative time associated with robotic surgery, mainly attributable to the robotic setup and docking; technical difficulties have been correlated with specific colorectal procedures such as simultaneous splenic flexure mobilization and rectal resection, for which a multi-quadrant approach is required [1, 7]. Due to these reasons, robotic surgery has rarely been described for the resection of transverse colon cancers. In recent years, few studies have demonstrated that laparoscopy is safe and feasible for transverse colon cancers, with the advantages associated with the minimally invasive approach, including less postoperative pain, faster recovery, and shorter hospital stay [8,9,10,11,12]
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