Abstract
Background
Recently, an operative strategy involving complete mesocolic excision (CME) and central vascular ligation (CVL) for colonic cancer has been introduced. We aimed to describe our initial experience and assess the long-term outcomes of robotic modified CME (mCME) and CVL (mCME+CVL) for right-sided colon cancer.
Methods
Of the 677 patients with histologically confirmed, right-sided colon adenocarcinoma who underwent curative mCME+CVL between February 2008 and October 2016, 43 who were treated entirely using the robotic approach were included in this retrospective study. Survival rates were determined using the Kaplan-Meier method, and P values of < 0.05 indicated statistically significant differences.
Results
The total operation and docking times were 293 (180–644) min and 5 (3–19) min, respectively, with an estimated blood loss of 50 (10–400) mL. The time to soft diet was 4 (1–16) days and the length of hospitalization was 8 (4–48) days. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IV complications were noted in 3 (7.0%), 5 (11.7%), 2 (4.7%), 1 (2.3%), and 0 (0%) patients, respectively. The proximal and distal resection margins were 14 (4–54) and 19 (4–48) cm, respectively, and 29 (6–157) lymph nodes were harvested per patient. The patients were followed-up for a median of 55 (2–109) months, during which the overall survival rate, median disease-free period, disease-free survival rate, and tumor recurrence rate were 93.6%, 38 (2–109) months, 81.1%, and 16.3% (7 patients), respectively.
Conclusions
Robotic mCME and CVL for right-sided colon cancer was feasible and safe. It can be added to the surgeon’s toolbox as an optional strategy for the management of colon cancer patients.
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References
Wibe A, Moller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, Langmark F, Myrvold HE, Soreide O (2002) A national strategic change in treatment policy for rectal cancer–implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 45(7):857–866
Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gögenur I, Danish Colorectal Cancer Group (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16(2):161–168
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis 11(4):354–364 discussion 364–355
Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N (2014) Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261:708–715. https://doi.org/10.1097/SLA.0000000000000831
Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, Park YA, Chun HK (2017) Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 32:2721–2731. https://doi.org/10.1007/s00464-017-5970-6
Bae SU, Kim CN (2015) Laparoscopic complete mesocolic excision and central vascular ligation for right-sided colon cancer using the retroperitoneal approach. Dis Colon Rectum 58(8):816
Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226
Tyler JA, Fox JP, Desai MM, Perry WB, Glasgow SC (2013) Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rectum 56(4):458–466
Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19(2):140–146
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Kariv Y, Delaney CP (2005) Robotics in colorectal surgery. Minerva Chir 60(5):401–416
Rawlings AL, Woodland JH, Crawford DL (2006) Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 20(11):1713–1718
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138(7):777–784
Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N (2015) Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261(4):708–715
Bertelsen CA, Neuenschwander AU, Jansen JE, Kirkegaard-Klitbo A, Tenma JR, Wilhelmsen M, Rasmussen LA, Jepsen LV, Kristensen B, Gögenur I, the Copenhagen Complete Mesocolic Excision Study (COMES), the Danish Colorectal Cancer Group (DCCG) (2016) Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg 103(5):581–589
Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y (2017) Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Color Dis 19(11):962–972
Spinoglio G, Bianchi PP, Marano A, Priora F, Lenti LM, Ravazzoni F, Petz W, Borin S, Ribero D, Formisano G, Bertani E (2018) Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 patients. Ann Surg Oncol 25:3580–3586. https://doi.org/10.1245/s10434-018-6752-7
Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2014) Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol 21(7):2288–2294
van Oostendorp S, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, Tuynman J (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31(1):64–77
Yeo SA, Noh GT, Han JH, Cheong C, Stein H, Kerdok A, Min BS (2017) Universal suprapubic approach for complete mesocolic excision and central vascular ligation using the da Vinci Xi(R) system: from cadaveric models to clinical cases. J Robot Surg 11:399–407. https://doi.org/10.1007/s11701-016-0664-y
Funding
This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2017R1C1B5076880).
This work was also supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).
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Drs. Bae, Yang, and Min have no conflicts of interest or financial ties to disclose.
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Bae, S.U., Yang, S.Y. & Min, B.S. Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes. Int J Colorectal Dis 34, 471–479 (2019). https://doi.org/10.1007/s00384-018-3208-2
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DOI: https://doi.org/10.1007/s00384-018-3208-2