Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST)

Abstract

Background The impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours. Methods This was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy—absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy. Results Some 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures. Conclusion No difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery.

Robotic versus laparoscopic right hemicolectomy: a systematic review of the evidence

“…Additional records were identified from secondary analyses in the field. After application of inclusion and exclusion criteria, 16 publications [ 6 , 8 , 9 , 27 – 39 ] were included in the qualitative analysis (Fig. 1 ).…”

“…Among them, three were propensity score-matched [ 27 – 29 ]. One study was prospective but non-randomized [ 39 ]. There was only one randomized controlled trial comparing robotic right hemicolectomy with laparoscopic right hemicolectomy [ 38 ].…”

“…Interventions (robotic right hemicolectomy) and controls (laparoscopic right hemicolectomy) differed widely in terms of extent of lymphadenectomy (complete mesocolic excision or not, D3 lymphadenectomy or not), type of anastomosis (intra-corporeal or extra-corporeal) and extraction sites (midline or off-midline), as reported in Table 3 . Of note, the MIRCAST study [ 39 ] compared robotic right hemicolectomy with either intra-corporeal anastomosis or extra-corporeal anastomosis with laparoscopic right hemicolectomy with either intra-corporeal anastomosis or extra-corporeal anastomosis. The number included patients ranged between 35 [ 38 ] to 6’521 patients [ 36 ] for the laparoscopic group, and between 35 [ 38 ] to 409 patients [ 39 ] for the robotic group.…”

“…Of note, the MIRCAST study [ 39 ] compared robotic right hemicolectomy with either intra-corporeal anastomosis or extra-corporeal anastomosis with laparoscopic right hemicolectomy with either intra-corporeal anastomosis or extra-corporeal anastomosis. The number included patients ranged between 35 [ 38 ] to 6’521 patients [ 36 ] for the laparoscopic group, and between 35 [ 38 ] to 409 patients [ 39 ] for the robotic group.…”

“…The number included patients ranged between 35 [ 38 ] to 6’521 patients [ 36 ] for the laparoscopic group, and between 35 [ 38 ] to 409 patients [ 39 ] for the robotic group.…”