Abstract
The current gold standard surgical treatment for right colonic malignancy is the laparoscopic right hemicolectomy (LRH). However, laparoscopic surgery has limitations which can be overcome by robotic surgery. The benefits of robotics for rectal cancer are widely accepted but its use for right hemicolectomy remains controversial. The aim of this study was to compare outcomes in patients undergoing robotic right hemicolectomy (RRH) and LRH in a university teaching hospital. Demographic, perioperative and postoperative data along with early oncological outcomes of patients who underwent RRH and LRH with extracorporeal anastomosis (ECA) were identified from a prospectively maintained database. A total of 70 patients (35 RRH, 35 LRH) were identified over a 4-year period. No statistically significant differences in estimated blood loss, conversion to open surgery, postoperative complications, anastomotic leak, 30-day reoperation, 30-day mortality, surgical site infection or lengths of stay were demonstrated. Surgical specimen quality in both groups was favourable. The mean duration of surgery was longer in RRH (p < < 0.00001). A statistically significant proportion of RRH patients had a higher BMI and ASA grade. The results demonstrate that RRH is safe and feasible when compared to LRH, with no statistical difference in postoperative morbidity, mortality and early oncological outcomes. A difference was noted in operating time, however was influenced by training residents in docking the robot and a technically challenging cohort of patients. Operative time has shortened with further experience. Incorporating an intracorporeal anastomosis technique in RRH offers the potential to improve outcomes compared to LRH.
Highlights
Invasive surgery is recognised as the gold standard of treatment for colon cancer due to welldemonstrated benefits in terms of 30-day post-operative outcomes and equivalent long-term oncological results compared to open approaches in numerous multicentre randomised controlled trials [1]
Between July 2016 and July 2020, 35 patients underwent robotic right hemicolectomy (RRH), which were case-matched to 35 patients that underwent laparoscopic right hemicolectomy (LRH) during the same time period in our institution which were randomly selected from the operating theatre logbooks to avoid selection bias
Patient baseline characteristics were comparable between the two groups apart from BMI, where a higher proportion of patients in the RRH cohort (48.6%) suffered with obesity compared to the LRH cohort (14.2%) (p = 0.001) (Table 1)
Summary
Invasive surgery is recognised as the gold standard of treatment for colon cancer due to welldemonstrated benefits in terms of 30-day post-operative outcomes and equivalent long-term oncological results compared to open approaches in numerous multicentre randomised controlled trials [1]. Invasive approaches to the right colon have been well described, with several studies showing that such techniques provide numerous advantages to open surgery that include lower intra-operative blood loss, less post-operative pain, faster recovery of intestinal function, a shorter hospital stay and earlier recovery of normal activity [2]. Right hemicolectomy for cancer is predominantly performed in high volume centres via a laparoscopic approach which has been demonstrated to be safe and feasible [3]. It has been shown that laparoscopic right hemicolectomy (LRH) has a significantly steeper learning curve than the open approach, and obtaining a proficiency in the technique can be challenging for trainee surgeons [5]
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