Advertisement

International Journal of Colorectal Disease

, Volume 34, Issue 3, pp 471–479 | Cite as

Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes

  • Sung Uk Bae
  • Seung Yoon Yang
  • Byung Soh MinEmail author
Original Article
  • 132 Downloads

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.

Keywords

Complete mesocolic excision Robotic modified CME Colon cancer 

Notes

Funding information

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).

Compliance with ethical standards

Conflicts of interest

Drs. Bae, Yang, and Min have no conflicts of interest or financial ties to disclose.

Supplementary material

ESM 1

(WMV 216772 kb)

References

  1. 1.
    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):857–866CrossRefGoogle Scholar
  2. 2.
    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):161–168CrossRefGoogle Scholar
  3. 3.
    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 364–355CrossRefGoogle Scholar
  4. 4.
    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 CrossRefGoogle Scholar
  5. 5.
    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 CrossRefGoogle Scholar
  6. 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):816CrossRefGoogle Scholar
  7. 7.
    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):1219–1226CrossRefGoogle Scholar
  8. 8.
    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):458–466CrossRefGoogle Scholar
  9. 9.
    Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19(2):140–146CrossRefGoogle Scholar
  10. 10.
    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):187–196CrossRefGoogle Scholar
  11. 11.
    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):205–213CrossRefGoogle Scholar
  12. 12.
    Kariv Y, Delaney CP (2005) Robotics in colorectal surgery. Minerva Chir 60(5):401–416Google Scholar
  13. 13.
    Rawlings AL, Woodland JH, Crawford DL (2006) Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 20(11):1713–1718CrossRefGoogle Scholar
  14. 14.
    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):777–784CrossRefGoogle Scholar
  15. 15.
    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):708–715CrossRefGoogle Scholar
  16. 16.
    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):581–589CrossRefGoogle Scholar
  17. 17.
    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):962–972CrossRefGoogle Scholar
  18. 18.
    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 CrossRefGoogle Scholar
  19. 19.
    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):2288–2294CrossRefGoogle Scholar
  20. 20.
    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):64–77CrossRefGoogle Scholar
  21. 21.
    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 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sung Uk Bae
    • 1
    • 2
  • Seung Yoon Yang
    • 2
  • Byung Soh Min
    • 2
    Email author
  1. 1.Division of Colorectal Surgery, Department of Surgery, School of MedicineKeimyung University and Dongsan Medical CenterDaeguSouth Korea
  2. 2.Department of Surgery, College of MedicineYonsei UniversitySeoulSouth Korea

Personalised recommendations