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Vela J, Riquoir C, Jarry C, Silva F, Besser N, Urrejola G, Molina ME, Miguieles R, Bellolio F, Larach JT. Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study. Surg Endosc 2024; 38:5114-5121. [PMID: 39028345 DOI: 10.1007/s00464-024-11086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Retrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC. METHODS Consecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM). RESULTS Two hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p = 0.657) and a shorter hospital stay (3 versus 4 days; p = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient = - 0.624; p = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1-6 cases), consolidation (7-13 cases), and mastery (after 13 cases). CONCLUSION The learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.
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Affiliation(s)
- Javier Vela
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Christophe Riquoir
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Cristián Jarry
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Felipe Silva
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Nicolás Besser
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Gonzalo Urrejola
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - María Elena Molina
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Rodrigo Miguieles
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - Felipe Bellolio
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile
| | - José Tomás Larach
- Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
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Wittmann M, Vladimirov M, Renz M, Thumfart L, Giulini L, Dubecz A. [Robotic vs. laparoscopic right hemicolectomy-An analysis of costs]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:651-655. [PMID: 38753005 DOI: 10.1007/s00104-024-02077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 07/30/2024]
Abstract
The use of robotic surgical methods for performing right-sided hemicolectomy has been somewhat controversial, primarily due to concerns related to costs. The purpose of this study is to document the initial robotic right hemicolectomies conducted at our institution and to compare them with a laparoscopic reference group. A significant focus of this study is the detailed analysis of the costs associated with both techniques within the German healthcare system.Surgical and cost-related data for 34 cases each for robotic and laparoscopic right-sided hemicolectomy performed at Nürnberg Hospital were compared. This comparison was conducted through a retrospective single-center case-matched analysis. Cost analysis was carried out following the current guidelines provided by the Institute for the Hospital Remuneration System (InEK) of Germany.The average age of the patient cohort was 70 years, with a male patient proportion of 57.4%. Analysis of perioperative parameters indicated similar outcomes for both surgical techniques. Regarding the incidence of complications of Clavien-Dindo stages III-V (8.8% vs. 17.6%; p = 0.48), a positive trend towards robotic surgery was observed. The cost analysis showed nearly identical total costs for the selected cases in both groups (mean €13,423 vs. €13,424; p = 1.00), with the most significant cost difference noted in surgical (operative) costs (€5,779 vs. €3,521; p < 0.01). The lower costs for laparoscopic cases were primarily due to the reduced material costs (mean €2,657 vs. €702; p < 0.05).In conclusion, both surgical approaches are clinically equivalent, with only minor differences in the total case costs.
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Affiliation(s)
- M Wittmann
- Universitätsklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - M Vladimirov
- Universitätsklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - M Renz
- Universitätsklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - L Thumfart
- Universitätsklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - L Giulini
- Universitätsklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - A Dubecz
- Universitätsklinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland.
- Abteilung für Allgemein- und Viszeralchirurgie, HELIOS Klinikum, Erfurt, Deutschland.
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Subramaniam S, Piozzi GN, Kim SH, Khan JS. Robotic approach to colonic resection: For some or for all patients? Colorectal Dis 2024; 26:1447-1455. [PMID: 38812078 DOI: 10.1111/codi.17046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
The robotic approach is rapidly gaining momentum in colorectal surgery. Its benefits in pelvic surgery have been extensively discussed and are well established amongst those who perform minimally invasive surgery. However, the same cannot be said for the robotic approach for colonic resection, where its role is still debated. Here we aim to provide an extensive debate between selective and absolute use of the robotic approach for colonic resection by combining the thoughts of experts in the field of robotic and minimally invasive colorectal surgery, dissecting all key aspects for a critical view on this exciting new paradigm in colorectal surgery.
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Affiliation(s)
- Sentilnathan Subramaniam
- Colorectal Surgery Unit, Department of General Surgery, Hospital Selayang, Selangor, Malaysia
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Seon-Hahn Kim
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jim S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
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Aghayeva A, Seker ME, Bayrakceken S, Kirbiyik E, Bagda A, Benlice C, Karahasanoglu T, Baca B. Comparison of Postoperative Outcomes and Long-Term Survival Rates between Patients Who Underwent Robotic and Laparoscopic Complete Mesocolic Excision for Right-Sided Colon Cancer. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38899434 DOI: 10.1089/lap.2024.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Introduction: Right colon cancer often requires surgical intervention, and complete mesocolic excision (CME) has emerged as a standard procedure. The study aims to evaluate and compare the safety and efficacy of robotic and laparoscopic CME for patients with right colon cancer and 5-year survival rates examined to determine the outcomes. Materials and Methods: Patients who underwent CME for right-sided colon cancer between 2014 and 2021 were included in this study. Group differences of age, body mass index, operation time, bleeding amount, total harvested lymph nodes, and postoperative stay were analyzed by the Mann-Whitney U test. Group differences of sex, American Society of Anesthesiology, and tumor, node, and metastasis stage were analyzed by the Chi-squared test. Disease-free and overall survival were assessed using Kaplan-Meier curves with the log-rank Mantel-Cox test. Results: From 109 patients, 74 of them were 1:1 propensity score matched and used for analysis. Total harvested lymph node (P ≤ .001) and estimated blood loss (P = .031) were found to be statistically significant between the groups. We found no statistically significant difference between the groups in terms of disease-free and overall survival (P = .27, .86, respectively), and the mortality rate was 9.17%, with no deaths directly attributed to the surgery. Conclusions: Study shows that minimally invasive surgery is a feasible option for CME in right colon cancers, with acceptable overall survival rates. Although the robotic approach has a higher lymph node yield, there was no significant difference in survival rates. Further randomized trials are needed to determine the clinical significance of both approaches.
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Affiliation(s)
- Afag Aghayeva
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mustafa Ege Seker
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Serra Bayrakceken
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ebru Kirbiyik
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Aysegul Bagda
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cigdem Benlice
- Department of General Surgery, School of Medicine, Ankara University, Ankara, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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5
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Xu J, Mohan HM, Fleming C, Larach JT, Apte SS, Cohen LCL, Miskovic D, Jiang W, Heriot AG, Warrier SK. Complete mesocolic excision versus standard resection for colon cancer: a systematic review and meta-analysis of perioperative safety and an evaluation of the use of a robotic approach. Tech Coloproctol 2023; 27:995-1005. [PMID: 37414915 DOI: 10.1007/s10151-023-02838-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches. METHODS Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches. RESULTS There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien-Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54). CONCLUSIONS Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this. PROSPERO ID CRD42021287065.
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Affiliation(s)
- J Xu
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.
| | - H M Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Austin Health, Melbourne, VIC, Australia
| | - C Fleming
- Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland
| | - J T Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - L C L Cohen
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | | | - W Jiang
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - A G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - S K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
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Jarrett R, West NP. Macroscopic Evaluation of Colon Cancer Resection Specimens. Cancers (Basel) 2023; 15:4116. [PMID: 37627144 PMCID: PMC10452811 DOI: 10.3390/cancers15164116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them.
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Affiliation(s)
| | - Nicholas P. West
- Pathology & Data Analytics, Leeds Institute of Medical Research, St. James’s University Hospital, School of Medicine, University of Leeds, Leeds LS9 7TF, UK
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Tian Y, Xiong D, Xu M, Fan Q, Zheng H, Shen H, Huang B, Wang L, Li C, Zhang A, Liu B, Li F, Gao F, Tong W. Robotic versus laparoscopic right hemicolectomy with complete mesocolic excision: a retrospective multicenter study with propensity score matching. Front Oncol 2023; 13:1187476. [PMID: 37333806 PMCID: PMC10273266 DOI: 10.3389/fonc.2023.1187476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Objective During the past decade, the concept of complete mesocolic excision (CME) has been developed in an attempt to minimize recurrence for right-sided colon cancer. This study aims to compare outcomes of robotic versus laparoscopic right hemicolectomy with CME for right-sided colon cancer. Methods We performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME. Data of all patients were retrospectively collected and reviewed. Of these, 149 cases were performed by a robotic approach, while the other 233 cases were done by laparoscopy. Propensity score matching was applied at a ratio of 1:1 to compare perioperative, pathologic, and oncologic outcomes between the robotic and the laparoscopic groups (n = 142). Results Before propensity score matching, there were no statistical differences regarding the sex, history of abdominal surgery, body mass index (BMI), American Joint Committee on Cancer (AJCC) staging system, tumor location, and center between groups (p > 0.05), while a significant difference was observed regarding age (p = 0.029). After matching, two comparable groups of 142 cases were obtained with equivalent patient characteristics (p > 0.05). Blood loss, time to oral intake, return of bowel function, length of stay, and complications were not different between groups (p > 0.05). The robotic group showed a significantly lower conversion rate (0% vs. 4.2%, p = 0.03), but a longer operative time (200.9 min vs. 182.3 min, p < 0.001) and a higher total hospital cost (85,016 RMB vs. 58,266 RMB, p < 0.001) compared with the laparoscopic group. The number of harvested lymph nodes was comparable (20.4 vs. 20.5, p = 0.861). Incidence of complications, mortality, and pathologic outcomes were similar between groups (p > 0.05). The 2-year disease-free survival rates were 84.9% and 87.1% (p = 0.679), and the overall survival rates between groups were 83.8% and 80.7% (p = 0.943). Conclusion Despite the limitations of a retrospective analysis, the outcomes of robotic right hemicolectomy with CME were comparable to the laparoscopic procedures with fewer conversions to open surgery. More clinical advantages of the robotic surgery system need to be further confirmed by well-conducted randomized clinical trials with large cohorts of patients.
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Affiliation(s)
- Yue Tian
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Dehai Xiong
- Department of Colorectum, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Ming Xu
- Department of Colorectum, The 940Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, China
| | - Qi Fan
- Department of Colorectum, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Huichao Zheng
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Haode Shen
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Bin Huang
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Li Wang
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Chunxue Li
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Anping Zhang
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Baohua Liu
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Fan Li
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
| | - Feng Gao
- Department of Colorectum, The 940Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, China
| | - Weidong Tong
- Department of General Surgery, Colorectal Division, Army Medical Center, Army Medical University, Chongqing, China
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Zheng J, Zhao S, Chen W, Zhang M, Wu J. Comparison of robotic right colectomy and laparoscopic right colectomy: a systematic review and meta-analysis. Tech Coloproctol 2023:10.1007/s10151-023-02821-2. [PMID: 37184773 DOI: 10.1007/s10151-023-02821-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND For right colon surgery, there is an increasing body of literature comparing the safety of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC). The aim of the present systematic review and meta-analysis is to assess the safety and efficacy of RRC versus LRC, including homogeneous subgroup analyses for extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). METHODS PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published between January 2000 and January 2022. Length of hospital stay, operation time, rate of conversion to laparotomy, time to first flatus, number of harvested lymph nodes, estimated blood loss, rate of overall complication, ileus, anastomotic leakage, wound infection, and total costs were measured. RESULTS Forty-two studies (RRC: 2772 patients; LRC: 12,469 patients) were evaluated. Regardless of the type of anastomosis, RRC showed shorter length of hospital stay, lower rate of conversion to laparotomy, shorter time to first flatus, lower rate of overall complications, and a higher number of harvested lymph nodes compared with LRC, but longer operative time and higher total costs. In the IA subgroup, RRC had a shorter length of hospital stay, longer operative time, and lower rate of conversion to laparotomy compared with LRC, with no difference for the remaining outcomes. In the EA subgroup, RRC had a longer operative time, lower estimated blood loss, lower rate of overall complications, and higher total costs compared with LRC, with the other outcomes being similar. CONCLUSION The safety and efficacy of RRC is superior to LRC, especially when an intracorporeal anastomosis is performed. Most included articles were retrospective, offering low-quality evidence and limited conclusions.
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Affiliation(s)
- Jianchun Zheng
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, Jiangsu Province, China
| | - Wei Chen
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Ming Zhang
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Jianxiang Wu
- Department of Emergency, The Second Hospital of Jiaxing: The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China.
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Cuk P, Jawhara M, Al-Najami I, Helligsø P, Pedersen AK, Ellebæk MB. Robot-assisted versus laparoscopic short- and long-term outcomes in complete mesocolic excision for right-sided colonic cancer: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:171-181. [PMID: 36001164 DOI: 10.1007/s10151-022-02686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes. METHODS Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2). RESULTS Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included. CONCLUSIONS This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mohamad Jawhara
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Issam Al-Najami
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
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10
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Sica GS, Vinci D, Siragusa L, Sensi B, Guida AM, Bellato V, García-Granero Á, Pellino G. Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review. Surg Endosc 2023; 37:846-861. [PMID: 36097099 PMCID: PMC9944740 DOI: 10.1007/s00464-022-09548-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several procedures have been proposed to reduce the rates of recurrence in patients with right-sided colon cancer. Different procedures for a radical right colectomy (RRC), including extended D3 lymphadenectomy, complete mesocolic excision and central vascular ligation have been associated with survival benefits by some authors, but results are inconsistent. The aim of this study was to assess the variability in definition and reporting of RRC, which might be responsible for significant differences in outcome evaluation. METHODS PRISMA-compliant systematic literature review to identify the definitions of RRC. Primary aims were to identify surgical steps and different nomenclature for RRC. Secondary aims were description of heterogeneity and overlap among different RRC techniques. RESULTS Ninety-nine articles satisfied inclusion criteria. Eight surgical steps were identified and recorded as specific to RRC: Central arterial ligation was described in 100% of the included studies; preservation of mesocolic integrity in 73% and dissection along the SMV plane in 67%. Other surgical steps were inconstantly reported. Six differently named techniques for RRC have been identified. There were 35 definitions for the 6 techniques and 40% of these were used to identify more than one technique. CONCLUSIONS The only universally adopted surgical step for RRC is central arterial ligation. There is great heterogeneity and consistent overlap among definitions of all RRC techniques. This is likely to jeopardise the interpretation of the outcomes of studies on the topic. Consistent use of definitions and reporting of procedures are needed to obtain reliable conclusions in future trials. PROSPERO CRD42021241650.
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Affiliation(s)
- Giuseppe S Sica
- Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy. .,Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy.
| | - Danilo Vinci
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Leandro Siragusa
- Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy.,Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Bruno Sensi
- Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy.,Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Andrea M Guida
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Vittoria Bellato
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy.,Ospedale IRCCS San Raffaele, Milan, Italy
| | - Álvaro García-Granero
- Colorectal Unit, Hospital Universitario Son Espases, Palma, Spain.,Applied Surgical Anatomy Unit, Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain.,Human Embryology and Anatomy Department, University of Islas Baleares, Palma, Spain
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.,Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
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11
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Oweira H, Reissfelder C, Elhadedy H, Rahbari N, Mehrabi A, Fattal W, Khan JS, Chaouch MA. Robotic colectomy with CME versus laparoscopic colon resection with or without CME for colon cancer: a systematic review and meta-analysis. Ann R Coll Surg Engl 2023; 105:113-125. [PMID: 35950970 PMCID: PMC9889180 DOI: 10.1308/rcsann.2022.0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION This systematic review with meta-analysis aimed to compare the robotic complete mesocolon excision (RCME) to laparoscopic colectomy (LC) with (LCME) or without CME (LC non-CME) in postoperative outcomes, harvested lymph nodes and disease-free survival. METHODS We performed a systematic review with meta-analysis according to PRISMA 2020 and AMSTAR 2 guidelines. RESULTS The literature search yielded seven comparative studies including 677 patients: 269 patients in the RCME group and 408 in the LC group. The pooled analysis concluded to a lower conversion rate in the RCME group (OR=0.17; 95% CI [0.04, 0.74], p=0.02). There was no difference between the two groups in terms of morbidity (OR=1.03; 95% CI [0.70, 1.53], p=0.87), anastomosis leakage (OR=0.83; 95% CI [0.18, 3.72], p=0.81), bleeding (OR=1.90; 95% CI [0.64, 5.58], p=0.25), wound infection (OR=1.37; 95% CI [0.51, 3.68], p=0.53), operative time (mean difference (MD)=36.32; 95% CI [-24.30, 96.93], p=0.24), hospital stay (MD=-0.94; 95% CI [-2.03, 0.15], p=0.09) and disease-free survival (OR=1.29; 95% CI [0.71, 2.35], p=0.41). In the subgroup analysis, the operative time was significantly shorter in the LCME group than RCME group (MD=50.93; 95% CI [40.05, 61.81], p<0.01) and we noticed a greater number of harvested lymph nodes in the RCME group compared with LC non-CME group (MD=8.96; 95% CI [5.98, 11.93], p<0.01). CONCLUSIONS The robotic approach for CME ensures a lower conversion rate than the LC. RCME had a longer operative time than the LCME subgroup and a higher number of harvested lymph nodes than the LC non-CME group.
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Affiliation(s)
- H Oweira
- Universitätsmedizin Mannheim, Heidelberg University, Germany
| | - C Reissfelder
- Universitätsmedizin Mannheim, Heidelberg University, Germany
| | - H Elhadedy
- Universitätsmedizin Mannheim, Heidelberg University, Germany
| | - N Rahbari
- Universitätsmedizin Mannheim, Heidelberg University, Germany
| | - A Mehrabi
- Universitätsmedizin Mannheim, Heidelberg University, Germany
| | - W Fattal
- Universitätsmedizin Mannheim, Heidelberg University, Germany
| | - JS Khan
- Queen Alexandra Hospital, UK
| | - MA Chaouch
- Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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12
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Comparison of robotic versus laparoscopic right colectomy node retrieval in the obese population. J Robot Surg 2023:10.1007/s11701-023-01529-7. [PMID: 36637737 DOI: 10.1007/s11701-023-01529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
Data are scarce comparing robotic and laparoscopic colectomy node retrieval based on body mass index or age. With differences in anastomosis, mobilization, and ligation between these approaches, obese and/or elderly patients undergoing robotic surgery may have differences in node yield compared to laparoscopy. A retrospective review was conducted between four institutions from February 1, 2019 through August 1, 2021, during which 144 right colectomies were performed. Benign pathology, open colectomies, and conversions to open were excluded. All included surgeons had at least five patients to ensure experience. The population was categorized by a robotic or laparoscopic approach. Records were reviewed focusing on age, body mass index, surgical approach, anastomosis, pathology, and node count. The node count was then compared by body mass index and age between the robotic or laparoscopic approach to identify differences. After applied exclusions and outlier analysis, our final sample consisted of 80 patients. Both body mass index and age were significant, (p = 0.002 and p = 0.005, respectively). Body mass index ≤ 25.0 and age < 60 years old had higher average node counts. These variables interacted, (p = 0.003); those with both < 60 years old and body mass index ≤ 25 showed the greatest number of nodes (36.9). Laparoscopy yielded more nodes in ≥ 60 years old than robotics (27.4 verses 20.9), though this was not significant (p = 0.68). Node retrieval in overweight and obese patients did not differ between approaches (p = 0.48). Both body mass index and age influence the number of nodes that can be extracted in right hemicolectomies by experienced surgeons.
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13
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Jin Q, Long D, Liu C, Jiang Y, Zhou W, Yao H, Liu K. A propensity score matching study of totally robotic right hemicolectomy versus robot-assisted right hemicolectomy. J Robot Surg 2022; 17:905-914. [DOI: 10.1007/s11701-022-01472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
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14
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de’Angelis N, Micelli Lupinacci R, Abdalla S, Genova P, Beliard A, Cotte E, Denost Q, Goasguen N, Lakkis Z, Lelong B, Manceau G, Meurette G, Perrenot C, Pezet D, Rouanet P, Valverde A, Pessaux P, Azagra S, Mege D, Di Saverio S, de Chaisemartin C, Espin-Basany E, Gaujoux S, Gómez-Ruiz M, Gronnier C, Karoui M, Spinoglio G. Robotic-assisted right colectomy. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC). J Visc Surg 2022; 159:212-221. [DOI: 10.1016/j.jviscsurg.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Tschann P, Szeverinski P, Weigl MP, Rauch S, Lechner D, Adler S, Girotti PNC, Clemens P, Tschann V, Presl J, Schredl P, Mittermair C, Jäger T, Emmanuel K, Königsrainer I. Short- and Long-Term Outcome of Laparoscopic- versus Robotic-Assisted Right Colectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:2387. [PMID: 35566512 PMCID: PMC9103048 DOI: 10.3390/jcm11092387] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 12/17/2022] Open
Abstract
Background: There is a rapidly growing literature available on right hemicolectomy comparing the short- and long-term outcomes of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). The aim of this meta-analysis is to revise current comparative literature systematically. Methods: A systematic review of comparative studies published between 2000 to 2021 in PubMed, Scopus and Embase was performed. The primary endpoint was postoperative morbidity, mortality and long-term oncological results. Secondary endpoints consist of blood loss, conversion rates, complications, time to first flatus, hospital stay and incisional hernia rate. Results: 25 of 322 studies were considered for data extraction. A total of 16,099 individual patients who underwent RRC (n = 1842) or LRC (n = 14,257) between 2002 and 2020 were identified. Operative time was significantly shorter in the LRC group (LRC 165.31 min ± 43.08 vs. RRC 207.38 min ± 189.13, MD: −42.01 (95% CI: −51.06−32.96), p < 0.001). Blood loss was significantly lower in the RRC group (LRC 63.57 ± 35.21 vs. RRC 53.62 ± 34.02, MD: 10.03 (95% CI: 1.61−18.45), p = 0.02) as well as conversion rate (LRC 1155/11,629 vs. RRC 94/1534, OR: 1.65 (1.28−2.13), p < 0.001) and hospital stay (LRC 6.15 ± 31.77 vs. RRC 5.31 ± 1.65, MD: 0.84 (95% CI: 0.29−1.38), p = 0.003). Oncological long-term results did not differ between both groups. Conclusion: The advantages of robotic colorectal procedures were clearly demonstrated. RRC can be regarded as safe and feasible. Most of the included studies were retrospective with a limited level of evidence. Further randomized trials would be suitable.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
- Private University in the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Markus P. Weigl
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Stephanie Rauch
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Stephanie Adler
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Paolo N. C. Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Veronika Tschann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
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16
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Cuk P, Kjær MD, Mogensen CB, Nielsen MF, Pedersen AK, Ellebæk MB. Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis. Surg Endosc 2021; 36:32-46. [PMID: 34724576 PMCID: PMC8741661 DOI: 10.1007/s00464-021-08782-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022]
Abstract
Background Robot-assisted surgery is increasingly adopted in colorectal surgery. However, evidence for the implementation of robot-assisted surgery for colon cancer is sparse. This study aims to evaluate the short-term outcomes of robot-assisted colon surgery (RCS) for cancer compared to laparoscopic colon surgery (LCS). Methods Embase, MEDLINE, and Cochrane Library were searched between January 1, 2005 and October 2, 2020. Randomized clinical trials and observational studies were included. Non-original literature was excluded. Primary endpoints were anastomotic leakage rate, conversion to open surgery, operative time, and length of hospital stay. Secondary endpoints were surgical efficacy and postoperative morbidity. We evaluated risk of bias using RoB2 and ROBINS-I quality assessment tools. We performed a pooled analysis of primary and secondary endpoints. Heterogeneity was assessed by I2, and possible causes were explored by sensitivity- and meta-regression analyses. Publication bias was evaluated by Funnel plots and Eggers linear regression test. The level of evidence was assessed by GRADE. Results Twenty studies enrolling 13,799 patients (RCS 1740 (12.6%) and LCS 12,059 (87.4%) were included in the meta-analysis that demonstrated RCS was superior regarding: anastomotic leakage (odds ratio (OR) = 0.54, 95% CI [0.32, 0.94]), conversion (OR = 0.31, 95% CI [0.23, 0.41]), overall complication rate (OR = 0.85, 95% CI [0.73, 1.00]) and time to regular diet (MD = − 0.29, 95% CI [− 0.56, 0.02]). LCS proved to have a shortened operative time compared to RCS (MD = 42.99, 95% CI [28.37, 57.60]). Level of evidence was very low according to GRADE. Conclusion RCS showed advantages in colonic cancer surgery regarding surgical efficacy and morbidity compared to LCS despite a predominant inclusion of non-RCT with serious risk of bias assessment and a very low level of evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08782-7.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, University Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mie Dilling Kjær
- Research Unit for Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Michael Festersen Nielsen
- Surgical Department, University Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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17
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Clarke EM, Rahme J, Larach T, Rajkomar A, Jain A, Hiscock R, Warrier S, Smart P. Robotic versus laparoscopic right hemicolectomy: a retrospective cohort study of the Binational Colorectal Cancer Database. J Robot Surg 2021; 16:927-933. [PMID: 34709537 DOI: 10.1007/s11701-021-01319-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
Robotic right hemicolectomy (RRC) may have technical advantages over the conventional laparoscopic right colectomy (LRC) due to higher degrees of rotation, articulation, and tri-dimensional imaging. There is growing literature describing advantages of RRC compared to LRC; however, there is a lack of evidence about safety, oncologic quality of surgery and cost. This study aimed to analyse complication rates, length of stay and nodal harvest in patients undergoing minimally invasive right hemicolectomy for colon cancer from a prospective Australasian colorectal cancer database. This was a retrospective cohort study using nearest neighbour matching. The Binational Colorectal Cancer Audit (BCCA) provided the data for analysis. The primary outcome was length of stay. Secondary outcomes were harvested lymph node count, anastomotic leak, postoperative haemorrhage, abdominal abscess, postoperative ileus, wound infections and non-surgical complications. 4977 patients who underwent robotic (n = 146) or laparoscopic (n = 4831) right hemicolectomy for right-sided colon cancer were included. For RRC, LOS was shorter (5 vs 6.9 days, p = 0.01) and nodal harvest was higher (22 vs 19, p = 0.04). For RRC, surgical complications (5.9% vs 14.2%, p < 0.004) and non-surgical complications (4.6% vs 11.7%, p = 0.007) were lower though there was no difference in return to theatre or inpatient death. Robotic right hemicolectomy is associated shorter LOS and marginally higher lymph node count, though this may reflect anastomotic technique rather than surgical platform. Longer term studies are required to establish differences in overall survival, incisional hernia rates and cost effectiveness.
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Affiliation(s)
- Edward M Clarke
- Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia.
| | - Jessica Rahme
- Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Tomas Larach
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Amrish Rajkomar
- General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Richmond, Melbourne, VIC, 3121, Australia
| | - Anshini Jain
- Department of Surgery, Eastern Health, Box Hill, Melbourne, VIC, 3128, Australia
| | - Richard Hiscock
- Translational Obstetrics Group, Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Satish Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Richmond, Melbourne, VIC, 3121, Australia
| | - Philip Smart
- Department of Surgery, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia.,General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Richmond, Melbourne, VIC, 3121, Australia
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18
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Anania G, Davies RJ, Bagolini F, Vettoretto N, Randolph J, Cirocchi R, Donini A. Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis. Tech Coloproctol 2021; 25:1099-1113. [PMID: 34120270 PMCID: PMC8419145 DOI: 10.1007/s10151-021-02471-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/30/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The introduction of complete mesocolic excision (CME) for right colon cancer has raised an important discussion in relation to the extent of colic and mesenteric resection, and the impact this may have on lymph node yield. As uncertainty remains regarding the usefulness of and indications for right hemicolectomy with CME and the benefits of CME compared with a traditional approach, the purpose of this meta-analysis is to compare the two procedures in terms of safety, lymph node yield and oncological outcome. METHODS We performed a systematic review of the literature from 2009 up to March 15th, 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two hundred eighty-one publications were evaluated, and 17 met the inclusion criteria and were included. Primary endpoints analysed were anastomotic leak rate, blood loss, number of harvested lymph nodes, 3- and 5-year oncologic outcomes. Secondary outcomes were operating time, conversion, intraoperative complications, reoperation rate, overall and Clavien-Dindo grade 3-4 postoperative complications. RESULTS In terms of safety, right hemicolectomy with CME is not inferior to the standard procedure when comparing rates of anastomotic leak (RR 0.82, 95% CI 0.38-1.79), blood loss (MD -32.48, 95% CI -98.54 to -33.58), overall postoperative complications (RR 0.82, 95% CI 0.67-1.00), Clavien-Dindo grade III-IV postoperative complications (RR 1.36, 95% CI 0.82-2.28) and reoperation rate (RR 0.65, 95% CI 0.26-1.75). Traditional surgery is associated with a shorter operating time (MD 16.43, 95% CI 4.27-28.60) and lower conversion from laparoscopic to open approach (RR 1.72, 95% CI 1.00-2.96). In terms of oncologic outcomes, right hemicolectomy with CME leads to a higher lymph node yield than traditional surgery (MD 7.05, 95% CI 4.06-10.04). Results of statistical analysis comparing 3-year overall survival and 5-year disease-free survival were better in the CME group, RR 0.42, 95% CI 0.27-0.66 and RR 0.36, 95% CI 0.17-0.56, respectively. CONCLUSIONS Right hemicolectomy with CME is not inferior to traditional surgery in terms of safety and has a greater lymph node yield when compared with traditional surgery. Moreover, right-sided CME is associated with better overall and disease-free survival.
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Affiliation(s)
- G Anania
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - F Bagolini
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - N Vettoretto
- Montichiari Surgery, ASST Spedali Civili, Brescia, Italy
| | - J Randolph
- Georgia Baptist College of Nursing. Mercer University, Atlanta, GA, USA
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Azienda Ospedaliera Di Terni, 05100, Terni, Italy.
| | - A Donini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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19
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Crane J, Hamed M, Borucki JP, El-Hadi A, Shaikh I, Stearns AT. Complete mesocolic excision versus conventional surgery for colon cancer: A systematic review and meta-analysis. Colorectal Dis 2021; 23:1670-1686. [PMID: 33934455 DOI: 10.1111/codi.15644] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022]
Abstract
AIM Complete mesocolic excision (CME) lacks consistent data advocating operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analysis, analysing population characteristics and perioperative, pathological and oncological outcomes. METHODS D3 extended lymphadenectomy dissection was considered comparable to CME, and D2 and D1 dissection to be comparable to conventional surgery. Outcomes reviewed included lymph node yield, R1 resection, overall complications, overall survival and disease-free survival. RESULTS In all, 3039 citations were identified; 148 studies underwent full-text reviews and 31 matched inclusion criteria: total cohort 26 640 patients (13 830 CME/D3 vs. 12 810 conventional). Overall 3- and 5-year survival was higher in the CME/D3 group compared with conventional surgery: relative risk (RR) 0.69 (95% CI 0.51-0.93, P = 0.016) and RR 0.78 (95% CI 0.64-0.95, P = 0.011) respectively. Five-year disease-free survival also demonstrated CME/D3 superiority (RR 0.67, 95% CI 0.52-0.86, P < 0.001), with similar findings at 1 and 3 years. There were no statistically significant differences between the CME/D3 and conventional group in overall complications (RR 1.06, 95% CI 0.97-1.14, P = 0.483) or anastomotic leak (RR 1.02, 95% CI 0.81-1.29, P = 0.647). CONCLUSIONS Meta-analysis suggests CME/D3 may have a better overall and disease-free survival compared to conventional surgery, with no difference in perioperative complications. Quality of evidence regarding survival is low, and randomized control trials are required to strengthen the evidence base.
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Affiliation(s)
- Jasmine Crane
- Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Mazin Hamed
- Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Joseph P Borucki
- Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Ahmed El-Hadi
- Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Irshad Shaikh
- Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adam T Stearns
- Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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Updates on Robotic CME for Right Colon Cancer: A Qualitative Systematic Review. J Pers Med 2021; 11:jpm11060550. [PMID: 34204803 PMCID: PMC8231645 DOI: 10.3390/jpm11060550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background. Complete mesocolic excision (CME) is a surgical technique introduced with the aim of ameliorating the oncologic results of colectomy. Various experiences have demonstrated favorable oncologic results of CME in comparison with standard colectomy, in which the principles of CME are not respected. The majority of the literature refers to open or laparoscopic CME. This review analyses current evidence regarding robotic CME for right colectomy. Methods. An extensive Medline (Pub Med) search for relevant case series, restricted to papers published in English, was performed, censoring video vignettes and case reports. Results. Fourteen studies (ten retrospective, four comparative series of robotic versus laparoscopic CME) were included, with patient numbers ranging from 20 to 202. Four different approaches to CME are described, which also depend on the robotic platform utilized. Intraoperative and early clinical results were good, with a low conversion and anastomotic leak rate and a majority of Clavien–Dindo complications being Grades I and II. Oncologic adequacy of the surgical specimens was found to be good, although a homogeneous histopathologic evaluation was not provided. Conclusions. Further large studies are warranted to define long-term oncologic results of robotic right colectomy with CME and its eventual benefits in comparison to laparoscopy.
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21
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Díaz-Vico T, Fernández-Hevia M, Suárez-Sánchez A, García-Gutiérrez C, Mihic-Góngora L, Fernández-Martínez D, Álvarez-Pérez JA, Otero-Díez JL, Granero-Trancón JE, García-Flórez LJ. Complete Mesocolic Excision and D3 Lymphadenectomy versus Conventional Colectomy for Colon Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2021; 28:8823-8837. [PMID: 34089109 DOI: 10.1245/s10434-021-10186-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUNDS Previous systematic reviews suggest that the implementation of 'complete mesocolon excision' (CME) for colon tumors entails better specimen quality but with limited long-term outcomes. We performed a meta-analysis to compare the pathological, perioperative, and oncological results of CME with conventional surgery (CS) in primary colon cancer. METHODS Embase, MEDLINE and CENTRAL databases were searched using Medical Subject Headings for CME and D3 lymphadenectomy. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 18,989 patients from 27 studies were included. Postoperative complications were higher in the CME group (relative risk [RR] 1.13, 95% confidence interval [CI] 1.04-1.22, I2 = 0%), while no differences were observed in terms of anastomotic leak (I2 = 0%) or perioperative mortality (I2 = 49%). CME was associated with a higher number of lymph nodes harvested (I2 = 95%), distance to high tie (I2 = 65%), bowel length (I2 = 0%), and mesentery area (I2 = 95%). CME also had positive effects on 3- and 5-year overall survival (RR 1.09, 95% CI 1.04-1.15, I2 = 88%; and RR 1.05, 95% CI 1.02-1.08, I2 = 62%, respectively) and 3-year disease-free survival (RR 1.10, 95% CI 1.04-1.17, I2 = 22%), as well as decreased local (RR 0.35, 95% CI 0.24-0.51, I2 = 51%) and distant recurrences (RR 0.71, 95% CI 0.60-0.85, I2 = 34%). CONCLUSIONS Limited evidence suggests that CME improves oncological outcomes with a higher postoperative adverse events rate but no increase in anastomotic leak rate or perioperative mortality, compared with CS.
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Affiliation(s)
- Tamara Díaz-Vico
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain.
| | - María Fernández-Hevia
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain.,Health Research Institute of the Principality of Asturias (ISPA), Asturias, Spain
| | - Aida Suárez-Sánchez
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - Carmen García-Gutiérrez
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - Luka Mihic-Góngora
- Department of Medical Oncology, Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, Spain
| | - Daniel Fernández-Martínez
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - José Antonio Álvarez-Pérez
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - Jorge Luis Otero-Díez
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - José Electo Granero-Trancón
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain
| | - Luis Joaquín García-Flórez
- Division of General Surgery, Department of Colorectal Surgery, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma s/n, 33011, Oviedo, Spain.,Health Research Institute of the Principality of Asturias (ISPA), Asturias, Spain.,Department of Surgery, University of Oviedo, Oviedo, Spain
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22
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Larach JT, Flynn J, Wright T, Rajkomar AKS, McCormick JJ, Kong J, Smart PJ, Heriot AG, Warrier SK. Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes. Surg Endosc 2021; 36:2113-2120. [PMID: 33844084 DOI: 10.1007/s00464-021-08498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
AIM This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer. METHODS Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. RESULTS Fifty-one patients were included; 25 (49%) of them had an RCME. The groups were evenly distributed in terms of demographic characteristics and tumour location. Operative time was similar between both groups, and no patients required conversion to open surgery. There were no differences in overall complications (16% in RCME vs. 26.9% in RRC; p = 0.499) or their profile between groups. There were no anastomotic leaks recorded, and the reoperation rates were similar (0% for RCME versus 3.8% for RRC; p = 1). In addition, the median length of hospital stay was similar in between the RCME and the RRC groups (4 [4-6] days versus 5 [3-8.5] days, respectively; p = 0.891). Whilst there were no differences in the TNM staging, the mean number of lymph nodes harvested with RCME was 37.7 (±12.9) compared to 21.8 (±7.5) with RCC (p < 0.001). CONCLUSION In our series, RCME was associated with a higher lymph node harvest and a similar morbidity profile compared to RCC. Further studies are required to validate these results and provide long-term oncologic outcomes.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Julie Flynn
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Timothy Wright
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Amrish K S Rajkomar
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Philip J Smart
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
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23
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The art of robotic colonic resection: a review of progress in the past 5 years. Updates Surg 2021; 73:1037-1048. [PMID: 33481214 PMCID: PMC8184527 DOI: 10.1007/s13304-020-00969-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/28/2020] [Indexed: 01/12/2023]
Abstract
Surgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.
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Larach JT, Flynn J, Kong J, Waters PS, McCormick JJ, Murphy D, Stevenson A, Warrier SK, Heriot AG. Robotic colorectal surgery in Australia: evolution over a decade. ANZ J Surg 2021; 91:2330-2336. [PMID: 33438361 DOI: 10.1111/ans.16554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite reports of increasing adoption of robotics in colorectal surgery worldwide, data regarding its uptake in Australasia are lacking. This study examines the trends of robotic colorectal surgery in Australia during the last 10 years. METHODS Data from patients undergoing robotic colorectal surgery with the da Vinci robotic platform between 2010 and 2019 were obtained. Overall, numbers of specific colorectal procedures across Australia were obtained from the Medicare Benefit Schedule data over the same period. Pearson's correlation analysis was used to determine the statistical trends of overall and specific robotic colorectal procedures over time. RESULTS A total of 6110 robotic general surgery procedures were performed across Australia during the study period. Of these, 3522 (57.6%) were robotic colorectal procedures. An increasing trend of overall robotic colorectal procedures was seen over 10 years (Pearson's coefficient of 0.875; P = 0.001). While this applied to both the public and private sectors, 90.7% of the procedures were undertaken in the private sector. Restorative rectal resections, rectopexies, and right hemicolectomies accounted for 82.6% of the robotic colorectal procedures performed during this period with an increasing trend seen over time for each intervention. Moreover, a robotic approach was utilized in 12.5%, 41.0% and 9.0% of all restorative rectal resections, rectopexies and right hemicolectomies undertaken in Australia during 2019, respectively. CONCLUSION Robotic colorectal surgery has increased dramatically in Australia over the last 10 years, especially in the private sector. Penetration of robotic colorectal surgery in the public healthcare system will require focussed cost-benefit evaluations and governmental investment.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julie Flynn
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peadar S Waters
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Andrew Stevenson
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
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Metastasis to lymph nodes around the vascular tie worsens long-term oncological outcomes following complete mesocolic excision and conventional colectomy for right-sided colon cancer. Tech Coloproctol 2021; 25:309-317. [PMID: 33398660 DOI: 10.1007/s10151-020-02378-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival. METHODS Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival. RESULTS There were 91 patients in the CME group (58 males, mean age 64 ± 16 years) and 192 patients in the CC group (96 males, mean age 66 ± 14 years). The mean number of harvested lymph nodes (CME: 42 ± 15 vs CC: 34 ± 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 ± 2.2 vs CC: 2.4 ± 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I-III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients. CONCLUSION LNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery.
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Guadagni S, Palmeri M, Bianchini M, Gianardi D, Furbetta N, Minichilli F, Di Franco G, Comandatore A, Di Candio G, Morelli L. Ileo-colic intra-corporeal anastomosis during robotic right colectomy: a systematic literature review and meta-analysis of different techniques. Int J Colorectal Dis 2021; 36:1097-1110. [PMID: 33486533 PMCID: PMC8119253 DOI: 10.1007/s00384-021-03850-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Robotic assistance could increase the rate of ileo-colic intra-corporeal anastomosis (ICA) during robotic right colectomy (RRC). However, although robotic ICA can be accomplished with several different technical variants, it is not clear whether some of these technical details should be preferred. An evaluation of the possible advantage of one respect to another would be useful. METHODS We conducted a systematic review of literature on technical details of robotic ileo-colic ICA, from which we performed a meta-analysis of clinical outcomes. The extracted data allowed a comparative analysis regarding the outcome of overall complication (OC), bleeding rate (BR) and leakage rate (LR), between (1) mechanical anastomosis with robotic stapler, versus laparoscopic stapler, versus totally hand-sewn anastomosis and (2) closure of enterocolotomy with manual double layer, versus single layer, versus stapled. RESULTS A total of 30 studies including 2066 patients were selected. Globally, the side-to-side, isoperistaltic anastomosis, realized with laparoscopic staplers, and double-layer closure for enterocolotomy, is the most common technique used. According to the meta-analysis, the use of robotic stapler was significantly associated with a reduction of the BR with respect to mechanical anastomosis with laparoscopic stapler or totally hand-sewn anastomosis. None of the other technical aspects significantly influenced the outcomes. CONCLUSIONS ICA fashioning during RRC can be accomplished with several technical variants without evidence of a clear superiority of anyone of these techniques. Although the use of robotic staplers could be associated with some benefits, further studies are necessary to draw conclusions.
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Affiliation(s)
- Simone Guadagni
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Fabrizio Minichilli
- Unit of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Annalisa Comandatore
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy ,Endo-CAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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Anania G, Arezzo A, Davies RJ, Marchetti F, Zhang S, Di Saverio S, Cirocchi R, Donini A. A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision. Int J Colorectal Dis 2021; 36:1609-1620. [PMID: 33644837 PMCID: PMC8280018 DOI: 10.1007/s00384-021-03891-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. METHODS PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios. RESULTS Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups. CONCLUSIONS Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.
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Affiliation(s)
- Gabriele Anania
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Alberto Arezzo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Richard Justin Davies
- grid.24029.3d0000 0004 0383 8386Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Marchetti
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Shu Zhang
- grid.452404.30000 0004 1808 0942Department of Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Salomone Di Saverio
- grid.18147.3b0000000121724807Department of General Surgery, University of Insubria, Varese, Italy
| | - Roberto Cirocchi
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
| | - Annibale Donini
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
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Genova P, Pantuso G, Cipolla C, Latteri MA, Abdalla S, Paquet JC, Brunetti F, de'Angelis N, Di Saverio S. Laparoscopic versus robotic right colectomy with extra-corporeal or intra-corporeal anastomosis: a systematic review and meta-analysis. Langenbecks Arch Surg 2020; 406:1317-1339. [PMID: 32902707 DOI: 10.1007/s00423-020-01985-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the present systematic review and meta-analysis is to compare laparoscopic right colectomy (LRC) versus robotic right colectomy (RRC) using homogeneous subgroup analyses for extra-corporeal anastomosis (EA) and intra-corporeal anastomosis (IA). METHODS MEDLINE, Scopus, and Web of Science databases were searched up to April 2020 for prospective or retrospective studies comparing LRC versus RRC on at least one short- or long-term outcome. The primary outcome was the length of hospital stay (LOS). The secondary outcomes included operative and pathological results, survival, and total costs. LRC and RRC were compared using three homogeneous subgroups: without distinction by the type of anastomosis, EA only, and IA only. Pooled data analyses were performed using mean difference (MD) and random effects model. RESULTS Thirty-seven of 448 studies were selected. The included patients were 21,397 for the LRC group and 2796 for the RRC group. Regardless for the type of anastomosis, RRC showed shorter LOS, lower blood loss, lower conversion rate, shorter time to flatus, and lower overall complication rate compared with LRC, but longer operative time and higher total costs. In the EA subgroup, RRC showed similar LOS, longer operative time, and higher costs compared with LRC, the other outcomes being similar. In the IA subgroup, RRC showed shorter LOS and longer operative time compared with LRC, with no difference for the remaining outcomes. CONCLUSIONS Most included articles are retrospective, providing low-quality evidence and limiting conclusions. The more frequent use of the IA seems to explain the advantages of RRC over LRC.
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Affiliation(s)
- Pietro Genova
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Gianni Pantuso
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Unit of General and Oncological Surgery, Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Calogero Cipolla
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Unit of General and Oncological Surgery, Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Mario Adelfio Latteri
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Unit of General and Oncological Surgery, Paolo Giaccone University Hospital, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Solafah Abdalla
- Department of Digestive Surgery and Surgical Oncology, Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Sud, 78 Rue du Général Leclerc, 94275, Le Kremlin Bicetre, France
| | - Jean-Christophe Paquet
- Unit of Digestive and Urologic Surgery, Groupe Hospitalier Nord-Essonne, Site de Longjumeau, 159 Rue du Président François Mitterrand, 91160, Longjumeau, France
| | - Francesco Brunetti
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Nicola de'Angelis
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris-Est Créteil (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 201, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
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Larach JT, Rajkomar AKS, Narasimhan V, Kong J, Smart PJ, Heriot AG, Warrier SK. Robotic complete mesocolic excision and central vascular ligation for right-sided colon cancer: short-term outcomes from a case series. ANZ J Surg 2020; 91:117-123. [PMID: 32783390 DOI: 10.1111/ans.16224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite conflicting data regarding oncological outcomes, studies demonstrate that complete mesocolic excision (CME) and central vascular ligation (CVL) for right-sided colon cancer removes significantly more tissue and yields higher lymph node counts when compared to conventional resection. This study aims to report the safety profile of CME and CVL in patients undergoing robotic surgery for right-sided colon cancer during the introduction of this technique across two institutions. METHODS Patients who underwent an elective robotic right colectomy with CME and CVL for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and April 2020 were included. Demographic, clinical, perioperative and histopathological variables were recorded and analysed. RESULTS Twenty patients (13 females) with a median age of 69 (23-83) years and median body mass index of 27 (19-46) were included. All of them had a pre-operative diagnosis of right-sided colon adenocarcinoma. Median operative time and blood loss were 140 (130-300) min and 30 (20-100) mL, respectively. There were no conversions or intra-operative complications. There were two post-operative complications recorded (one ileus and one intra-abdominal collection treated with intravenous antibiotics) and no re-interventions. Median length of stay was 4 (2-8) days. All patients had an R0 resection, and the median lymph node yield was 36 (22-80) lymph nodes. CONCLUSION This series demonstrates a safe introduction of robotic CME and CVL in patients with right-sided colon cancer. The lymph node harvest obtained with CME and CVL in this setting was high.
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Affiliation(s)
- José T Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Unidad de Coloproctología, Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Amrish K S Rajkomar
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Philip J Smart
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Victoria, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Robotic complete mesocolic excision for transverse colon cancer can be performed with a morbidity profile similar to that of conventional laparoscopic colectomy. Tech Coloproctol 2020; 24:1035-1042. [DOI: 10.1007/s10151-020-02249-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
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Ceccarelli G, Costa G, Ferraro V, De Rosa M, Rondelli F, Bugiantella W. Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison. Surg Endosc 2020; 35:2039-2048. [PMID: 32372219 DOI: 10.1007/s00464-020-07600-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/23/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND We describe our preliminary experience in complete mesocolic excision (CME) with central vascular ligation (CVL) and intracorporeal anastomosis for right colon cancer, comparing the robotic and the three-dimensional (3D) laparoscopic approach. METHODS We performed a retrospective observational clinical cohort study on patients who underwent radical curative surgical resection of right colon cancer with CME from January 2014 to June 2019. Propensity scores were calculated by bivariate logistic regression, including the following variables: age, BMI, and size of tumor. RESULTS Fifty-five patients underwent CME with CVL: 26 by means of robot-assisted surgery and 29 by means of 3D laparoscopic procedure. There were not statistically significant differences about all the intra- and postoperative outcomes (operative time, length of the specimen, time to bowel canalization, time to soft oral intake, length of hospital stay, postoperative complication, number of retrieved lymph nodes, number of positive lymph nodes and lymph node ratio) between the robotic and the 3D laparoscopic approach. After the matching procedure, 20 patients of the robotic group and 20 patients of the 3D laparoscopic group were selected for the analysis. There were no differences in any of the analyzed variables between the two groups except for longer operative time in the robotic group (p = 0.002). CONCLUSION The 3D vision revealed an important advantage in order to achieve the correct identification of surgical anatomy allowing a safe and effective right colectomy with CME, CVL, and intracorporeal anastomosis, either using laparoscopic or with robotic approach, providing similar short-term outcomes. Taking into account the high costs and the longer operative time of robotic procedure, the 3D laparoscopy could be considered in performing right colectomy with CME, while the robotic approach should be considered as a first choice approach for challenging situations (obese patient, complex associated procedures).
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery, San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone, 1, 06034, Foligno, PG, Italy.,General Surgery, ASL Toscana Sud-Est, San Donato" Hospital, Via Pietro Nenni, 1, 52100, Arezzo, Italy
| | - Gianluca Costa
- Emergency Surgery Unit, "Sant'Andrea" Hospital, Sapienza" University of Rome, Via di Grottarossa, 1035, 00189, Roma, Italy
| | - Valentina Ferraro
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, Policlinic of Bari, University "A. Moro" of Bari, Piazza Giulio Cesare, 1, 70124, Bari, Italy
| | - Michele De Rosa
- General Surgery, San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone, 1, 06034, Foligno, PG, Italy
| | - Fabio Rondelli
- General Surgery, San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone, 1, 06034, Foligno, PG, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Walter Bugiantella
- General Surgery, San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone, 1, 06034, Foligno, PG, Italy.
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Zeng Y, Wang G, Liu Y, Li Z, Yi B, Zhu S. The "Micro Hand S" Robot-Assisted Versus Conventional Laparoscopic Right Colectomy: Short-Term Outcomes at a Single Center. J Laparoendosc Adv Surg Tech A 2020; 30:363-368. [PMID: 32013727 DOI: 10.1089/lap.2019.0714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: To evaluate the safety and feasibility of using the Micro Hand S surgical robot for right colectomy by comparing the short-term efficacy of robot-assisted and laparoscopic right colectomy (LRC). Methods: Data from a total of 22 patients who underwent right colectomy from January 2018 to February 2019 in the Department of Gastrointestinal Surgery, in the Third Xiangya Hospital of Central South University, were collected retrospectively. This included 10 patients who underwent robot-assisted right colectomy with the Micro Hand S surgical robot (RRC group [Shangdong Wego Surgical Robot Co., LTD, Weihai, China]) and 12 patients who underwent LRC group. The operation time, blood loss, number of lymph nodes dissected, time to first flatus, comprehensive complication index (CCI), and postoperative hospital stay were compared. Results: Compared with the LRC group, the RRC group had a lower CCI (11.7 ± 8.3 versus 19.9 ± 6.4, P < .05), shorter hospital stay (11.4 ± 3.3 versus 15.2 ± 4.7 days, P < .05). The differences were statistically significant. Conclusion: The Micro Hand S robot-assisted right colectomy is safe and feasible.
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Affiliation(s)
- Yijia Zeng
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guohui Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yong Liu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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