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Robotic versus laparoscopic left colectomy with complete mesocolic excision for left-sided colon cancer: a multicentre study with propensity score matching analysis

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Abstract

Background

Robotic surgery for right-sided colon and rectal cancer has rapidly increased; however, there is limited evidence in the literature of advantages of robotic left colectomy (RLC) for left-sided colon cancer. The purpose of this study was to compare the outcomes of RLC versus laparoscopic left colectomy (LLC) with complete mesocolic excision (CME) for left-sided colon cancer.

Methods

Patients who had RLC or LLC with CME for left-sided colon cancer at 5 hospitals in China between January 2014 and April 2022 were included. A one-to-one propensity score matched analysis was performed to decrease confounding. The primary outcome was postoperative complications occurring within 30 days of surgery. Secondary outcomes were disease-free survival, overall survival and the number of harvested lymph nodes.

Results

A total of 292 patients (187 males; median age 61.0 [20.0−85.0] years) were eligible for this study, and propensity score matching yielded 102 patients in each group. The clinical–pathological characteristics were well-matched between groups. The two groups did not differ in estimated blood loss, conversion to open rate, time to first flatus, reoperation rate, or postoperative length of hospital stay (p > 0.05). RLC was associated with a longer operation time (192.9 ± 53.2 vs. 168.9 ± 52.8 minutes, p=0.001). The incidence of postoperative complications did not differ between the RLC and LLC groups (18.6% vs. 17.6%, p = 0.856). The total number of lymph nodes harvested in the RLC group was higher than that in the LLC group (15.7 ± 8.3 vs. 12.1 ± 5.9, p< 0.001). There were no significant differences in 3-year and 5-year overall survival or 3-year and 5-year disease-free survival.

Conclusions

Compared to laparoscopic surgery, RLC with CME for left-sided colon cancer was found to be associated with higher numbers of lymph nodes harvested and similar postoperative complications and long-term survival outcomes.

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Acknowledgements

We thank surgeons Yue Tian, Yu Gao, Zhengyong Liu, Haode Shen, Guodong Xiao, Zhigang Ke, and Xiangfeng Wang and scrub nurses Feifei Huang and Liyuan Yao for great teamwork in the operating room. This study was supported by the Municipal Natural Science Foundation of Chongqing (cstc2021jcyj-msxmX0477), a grant from the National Clinical Key Specialty Construction Projects (4246ZA5), and a clinical innovation project of Army Medical University (2019CXLCB004).

Funding

This study was supported by the Municipal Natural Science Foundation of Chongqing (cstc2021jcyj-msxmX0477), a grant from the National Clinical Key Specialty Construction Projects (4246ZA5), and a clinical innovation project of Army Medical University (2019CXLCB004).

Author information

Author notes

  1. H. Zheng, Q. Wang, T. Fu and Z. Wei have co-firsts authors.

Authors and Affiliations

  1. Gastric and Colorectal Surgery Division, Department of General Surgery, Army Medical Center (Daping Hospital), Army Medical University, No. 10, Changjiang Branch Road, Daping, Yuzhong District, Chongqing, China

    H. Zheng, B. Huang, C. Li, B. Liu, A. Zhang, F. Li & W. Tong

  2. Department of Gastrocolorectal Surgery, The First Hospital of Jilin University, Changchun, China

    Q. Wang

  3. Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, Wuhan, China

    T. Fu

  4. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Z. Wei

  5. Department of Gastrointestinal Surgery, The People’s Hospital of Shapingba District, Chongqing, China

    J. Ye

  6. Department of Colorectal Surgery, 940th Hospital of Joint Logistics Support force of PLA, Lanzhou, China

    F. Gao

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  1. H. Zheng
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Contributions

(I) Conception and design: WT, HZ, and JY; (II) Manuscript writing: HZ, Weidong Tong; (III) Manuscript revision and English polishing: WT; (IV) Collection and assembly of data: HZ, BH, QW, ZW, TF, and FG; (V) Data analysis and interpretation: BL, FL, CL, and AZ; (VI) Administrative, technical, or material support: QW, ZW, Tao Fu, FG, and WT; (VII) Final approval of manuscript: All authors.

Corresponding authors

Correspondence to F. Li, F. Gao or W. Tong.

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Conflict of interest

All authors declare no conflicts-of-interest related to this article.

Ethical approval

This study was approved by the ethical committee of Army Medical University DaPing hospital (Project ID: 2021246). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Written informed consent for publication was obtained from all participants.

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Zheng, H., Wang, Q., Fu, T. et al. Robotic versus laparoscopic left colectomy with complete mesocolic excision for left-sided colon cancer: a multicentre study with propensity score matching analysis. Tech Coloproctol 27, 559–568 (2023). https://doi.org/10.1007/s10151-023-02781-7

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