Predictors of surgical outcomes of minimally invasive right colectomy: the MERCY study

de’Angelis, Nicola; Pattacini, Gianmaria Casoni; Winter, D. C.; Aisoni, Filippo; Bianchi, Giorgio; Carcoforo, Paolo; Celentano, Valerio; Coccolini, Federico; Saverio, Salomone Di; Frontali, Alice; Denet, Christine; Fuks, David; Genova, Pietro; Guerrieri, Mario; Kraft, Miquel; Lakkis, Zaher; Antonot, Céphise; Vertier, Jeanne; Roy, Bertrand Le; Lupinacci, Renato Micelli; Martínez‐Pérez, Aleix; Palma, Giovanni Domenico De; Milone, Marco; Orci, Lorenzo A.; Bartoletti, Sebastiano; O’Connell, Lauren; Ortenzi, Monica; Paquet, Jean-Christophe; Perrotto, Ornella; Petri, Roberto; Santangelo, Antonio; Scabini, Stefano; Rosa, Raffaele De; Tonini, Valeria; Valverde, A.; Andolfi, Enrico; Pecchini, Francesca; Pellino, Gianluca; Urbani, Alessia; Vidal, Laura; Restivo, Angelo; Deidda, Simona; Zorcolo, Luigi; Ris, Frédéric; Espín, Eloy; Piccoli, Micaela

doi:10.1007/s00384-022-04095-w

Cited by 8 publications

(9 citation statements)

References 41 publications

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“…Unlike previous studies, it focused exclusively on a large sample of minimallyinvasive right colectomies (either robotic or laparoscopic) for colon cancer through the stratification of data by quartiles of OT. In the case of right colectomy, the current evidence clearly supports MIS [18][19][20]24] and IA [27,[47][48][49] over open surgery and EA, as respectively related to superior short-term outcomes and enhanced recovery, despite longer OT. Thus, it was pertinent to assess whether OT had an impact on postoperative outcomes in the context of the most applied MIS procedures to treat right colon cancer.…”

Section: Ta B L E 3 Predictors Of Prolonged Operative Time (≥200 Min)mentioning

confidence: 69%

“…The present study was based on the Minimally-invasivE surgery for oncological Right ColectomY (MERCY) Study Group database [27], which was created as a multicentre (21 European surgical units) retrospective cohort of adult patients with nonmetastatic right colon adenocarcinoma (AJCC 0 to III [28]). It included elective curative-intent right colectomies, with at least standard D2-lymphoadenectomy [29], performed either by laparoscopy or robotic surgery (by Intuitive da Vinci Surgical Systems) between January 2014 and December 2020.…”

Section: Methodsmentioning

confidence: 99%

“…All procedures were performed by colorectal surgeons having completed their learning curve in MIS. Either extracorporal (EA) or intracorporeal (IA) ileocolonic anastomosis was performed according to standardized surgical techniques [27].…”

Section: Methodsmentioning

confidence: 99%

“…These are indicators of more complex and technically challenging procedures. The routine use of ICG fluorescence is not yet recommended and in the MERCY cohort was not systematically applied[27]. It concerned only 10.7% of patients upon discretion of the operating surgeon and more frequently during RRC (35.6%) than LRC (7%), probably due to fact that ICG fluorescence device is embedded in the robotic platform.…”

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confidence: 99%

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Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

de’Angelis

Schena

Piccoli³

et al. 2022

Colorectal Disease

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Aim: Operation time (OT) is a key operational factor influencing surgical outcomes. The present study aimed to analyse whether OT impacts on short-term outcomes of minimally-invasive right colectomies by assessing the role of surgical approach (robotic [RRC] or laparoscopic right colectomy [LRC]), and type of ileocolic anastomosis (i.e., intracorporal [IA] or extra-corporal anastomosis [EA]). Methods: This was a retrospective analysis of the Minimally-invasivE surgery for oncological Right ColectomY (MERCY) Study Group database, which included adult patients with nonmetastatic right colon adenocarcinoma operated on by oncological RRC or LRC between January 2014 and December 2020. Univariate and multivariate analyses were used. Results:The study sample was composed of 1549 patients who were divided into three groups according to the OT quartiles: (1) First quartile, <135 min (n = 386); (2) Second and third quartiles, 135-199 min (n = 731); and (3) Fourth quartile ≥200 min (n = 432). The majority (62.7%) were LRC-EA, followed by LRC-IA (24.3%), RRC-IA (11.1%), and RRC-EA (1.9%). Independent predictors of an OT ≥ 200 min included male gender, age, obesity, diabetes, use of indocyanine green fluorescence, and IA confection. An OT ≥ 200 min was significantly associated with an increased risk of postoperative noninfective complications (AOR: 1.56; 95% CI: 1.15-2.13; p = 0.004), whereas the surgical approach and the type of anastomosis had no impact on postoperative morbidity. Conclusion:Prolonged OT is independently associated with increased odds of postoperative noninfective complications in oncological minimally-invasive right colectomy.

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Section: Ta B L E 3 Predictors Of Prolonged Operative Time (≥200 Min)mentioning

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

de’Angelis

Schena

Piccoli³

et al. 2022

Colorectal Disease

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“…It is known from other analyses that the frequency and type of secondary diagnosis can also affect mortality [ 43 , 44 ]. However, we could not observe this in our study collective with appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study

Schildberg

Reißig

Hunger

et al. 2022

JCM

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Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.

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Right Colectomy with Intracorporeal Anastomosis: A European Multicenter Propensity Score Matching Retrospective Study of Robotic Versus Laparoscopic Procedures

de’Angelis

Piccoli²,

Pattacini³

et al. 2023

World j. surg.

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Background This study aimed to compare the short-and long-term outcomes of robotic (RRC-IA) versus laparoscopic (LRC-IA) right colectomy with intracorporeal anastomosis using a propensity score matching (PSM) analysis based on a large European multicentric cohort of patients with nonmetastatic right colon cancer. Methods Elective curative-intent RRC-IA and LRC-IA performed between 2014 and 2020 were selected from the MERCY Study Group database. The two PSM-groups were compared for operative and postoperative outcomes, and survival rates. Results Initially, 596 patients were selected, including 194 RRC-IA and 402 LRC-IA patients. After PSM, 298 patients (149 per group) were compared. There was no statistically significant difference between RRC-IA and LRC-IA in terms of operative time, intraoperative complication rate, conversion to open surgery, postoperative morbidity (19.5% in RRC-IA vs. 26.8% in LRC-IA; p = 0.17), or 5-yr survival (80.5% for RRC-IA and 74.7% for LRC-IA; p = 0.94). R0 resection was obtained in all patients, and [ 12 lymph nodes were harvested in 92.3% of patients, without group-related differences. RRC-IA procedures were associated with a significantly higher use of indocyanine green fluorescence than LRC-IA (36.9% vs. 14.1%; OR: 3.56; 95%CI 2.02-6.29; p \ 0.0001). Conclusion Within the limitation of the present analyses, there is no statistically significant difference between RRC-IA and LRC-IA performed for right colon cancer in terms of short-and long-term outcomes. Nicola de'Angelis and Micaela Piccoli have contributed equally.

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Predictors of surgical outcomes of minimally invasive right colectomy: the MERCY study

Cited by 8 publications

References 41 publications

Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study

Right Colectomy with Intracorporeal Anastomosis: A European Multicenter Propensity Score Matching Retrospective Study of Robotic Versus Laparoscopic Procedures

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