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

Abstract

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.

Robotic approach to colonic resection: For some or for all patients?

“…RAS is a cornerstone technique that has led to a paradigm shift in the field of MIS; however, every rose has its thorns. The robotic approach may not be practical for all colonic surgery due to its requirements for a specifically designed operating theatre, a trained robotic team and an expensive platform as well as not being cost-and timeeffective, especially if it confers no superiority in terms of oncological and postoperative outcomes, as suggested by many studies [11][12][13]. It is therefore not realistic to routinely utilize RAS, which has yet to attain equal accessibility worldwide, for all colonic resections, and particularly for malignancies that require time-critical treatment.…”

“…This is now slowly becoming a routine procedure along with right hemicolectomy for malignant indications of curative intent. In the context of oncological outcome, there is no difference between the use of RAS or LS to perform this procedure [11,12,20,21], but the precision and safety of performing extended lymph node dissection using RAS is greater and beneficial in patients with a high body mass index. The learning curve for robotic and laparoscopic right hemicolectomy with CME and CVL (27 and 32 cases, respectively) also shows that RAS shortens the learning curve for gaining proficiency in this procedure [22,23].…”