Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Abstract

Background: Colon cancer resection can be technically difficult in the obese (OB) population. Robotic surgery is a promising technique but its benefits remain uncertain in OB patients. The aim of this study is to compare OB versus non-obese (NOB) patients undergoing robotic colon surgery, as well as OB patients undergoing robotic versus open or laparoscopic colonic surgery. Methods: A systematic review and meta-analysis was performed. Primary outcome measures included length of stay (LOS), surgical site infection (SSI) rate, complications, anastomotic leak and oncological outcomes. Results: A total of eight studies were included, with five comparing OB and NOB patients undergoing robotic colon surgery included in meta-analysis. A total of 263 OB patients and 400 NOB patients formed the sample for meta-analysis. There was no significant difference between the two groups in operative time, conversion to open, LOS, lymph node yield, anastomotic leak and postoperative ileus. There was a trend towards a significant increase in overall complications and SSI in the OB group (32.3% OB versus 26.8% NOB for complications, 14.2% OB versus 9.9% NOB for SSI). The three included studies comparing surgical techniques were too heterogeneous to undergo meta-analysis. Conclusion: Robotic colon surgery is safe in obese patients, but high-quality prospective evidence is lacking. Future studies should report on oncological safety and the costeffectiveness of adopting the robotic technique in these challenging patients.

Analysis of short-term outcome indicators and risk factors for postoperative complications in patients with sigmoid colon cancer by transumbilical single-port plus one port laparoscopy

“…Furthermore, the presence of a significant amount of abdominal adipose tissue limits the surgical view, particularly for laparoscopic surgery [31]. Obese individuals are more prone to cardiovascular, respiratory and metabolic conditions and are less resilient to surgical stress [32]. It has been observed that obese patients have a higher likelihood of intraoperative incidents, a slower postoperative recovery and an increased risk of postoperative complications.…”

Colorectal Cancer and the Obese Patient: A Call for Guidelines

“…Obesity is a recognized independent risk factor for SSI [ 23 ]. A recent systematic review and meta-analysis (2022) of obese versus non-obese patients undergoing robotic colon surgery noted increased surgical site infections (SSI) in the obese patients but found no significant differences in operative time, conversion to open, or anastomotic leak rates [ 24 ]. Stoma formation in this group of patients can be technically challenging due to the thick abdominal wall and/or short mesentery.…”

Robotic colorectal surgery: evolution of its place

“…The first, from Ngu et al 1 . examines the use of the da Vinci Xi in multi‐visceral surgery; and the second, from Wang et al 2 . presents a review of robotic surgery in the obese.…”

“…The Wang et al . paper 2 looking at robotic surgery in the obese again demonstrates that high‐quality randomized trial data are lacking in this area, but does demonstrate robotic surgery to be safe in this challenging patient group. The aim of this study is to assess and compare the technical safety and short‐term surgical outcomes of obese patients having robotic colonic surgery, compared with non‐obese patients.…”

“…There are two interesting papers in this issue of the Journal that look at areas in colorectal surgery that are a challenge for all of us. The first, from Ngu et al 1 examines the use of the da Vinci Xi in multi-visceral surgery; and the second, from Wang et al 2 presents a review of robotic surgery in the obese. Both of these are complex areas that can be surgically challenging from multiple points of view-planning, access, patient positioning, prolonged operating times, managing comorbidity and achieving complete oncological resection.…”