Abstract
Background
In minimally invasive surgery, complete mesocolic excision (CME) for transverse colon cancer is challenging; thus, non-CME resections are commonly preferred when laparoscopy is used. Robotic technology has been developed to reduce the limitations of laparoscopy. The aim of our study was to evaluate whether robotic CME for transverse colon cancer can be performed with short-term outcomes similar to those of laparoscopic conventional colectomy (CC).
Methods
A retrospective review of 118 consecutive patients having robotic CME or laparoscopic CC for transverse colon cancer in two specialized centers between May 2011 and September 2018 was performed. Perioperative 30-day outcomes of the two procedures were compared.
Results
There were 38 and 80 patients in the robotic CME group and laparoscopic CC group, respectively. The groups were comparable regarding preoperative characteristics. Intraoperative results were similar, including blood loss (median 50 vs 25 ml), complications (5.3% vs 3.8%), and conversions (none vs 7.5%). The rate of intracorporeal anastomosis was significantly higher (86.8% vs 20.0%), mean operative time was longer (325.0 ± 123.2 vs 159.3 ± 56.1 min (p < 0.001), and the mean number of harvested lymph nodes was higher in the robotic CME group (46.1 ± 22.2 vs 39.1 ± 17.8, p = 0.047). There were only minor differences in length of hospital stay (7.2 ± 3.1 vs 7.9 ± 4.0 days), anastomotic leak (none vs 2.6%), bleeding (none vs 1.3%), surgical site infections (10.5% vs 12.5%), and reoperations (2.6% vs 6.3%).
Conclusions
Robotic CME can be performed with a similar morbidity profile as laparoscopic CC for transverse colon cancer along with a higher rate of intracorporeal anastomosis, and higher number of lymph nodes retrieved, but longer operative times.
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References
Hohenberger W, Weber K, Matzel K et al (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis 11:354–364
Søndenaa K, Quirke P, Kennedy RH et al (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 29:419–428
Merkel S, Weber K, Matzel KE et al (2016) Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision. Br J Surg 103:1220–1229
Brouwer NPM, Hugen N, Nagtegaal ID (2020) More extensive lymphadenectomy in colon cancer; how far are we willing to go for a biomarker? Tech Coloproctol. https://doi.org/10.1007/s10151-020-02239-0
Schlachta CM, Mamazza J, Poulin EC (2007) Are transverse colon cancers suitable for laparoscopic resection? Surg Endosc 21:396–399
Fernández-Cebrián JM, Gil Yonte P, Jimenez-Toscano M et al (2013) Laparoscopic colectomy for transverse colon carcinoma: a surgical challenge but oncologically feasible. Colorectal Dis 15:e79–83
Ichihara T, Takada M, Fukumoto S et al (2004) Lymphadenectomy along the middle colic artery in laparoscopic resection of transverse colon. Hepatogastroenterology 51:455–456
Mori S, Kita Y, Baba K et al (2017) Laparoscopic complete mesocolic excision via combined medial and cranial approaches for transverse colon cancer. Surg Today 47:643–649
Ozben V, de Muijnck C, Esen E et al (2018) Is robotic complete mesocolic excision feasible for transverse colon cancer? J Laparoendosc Adv Surg Tech A 28:1443–1450
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Aghayeva A, Baca B, Atasoy D et al (2016) Robotic complete mesocolic excision for splenic flexure of colon cancer. Dis Colon Rectum 59:1098
Yozgatli TK, Aytac E, Ozben V et al (2019) Robotic complete mesocolic excision versus conventional laparoscopic hemicolectomy for right-sided colon cancer. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2018.0348(Epub ahead of print)
Storli KE, Eide GE (2016) Laparoscopic complete mesocolic excision versus open complete mesocolic excision for transverse colon cancer: long-term survival results of a prospective single centre non-randomized study. Dig Surg 33:114–120
Wang Y, Zhang C, Feng YF et al (2017) Comparison of short-term outcomes between laparoscopic-assisted and open complete mesocolic excision (CME) for the treatment of transverse colon cancer. Chin Clin Oncol 6:6
Matsuda T, Sumi Y, Yamashita K et al (2018) Anatomical and embryological perspectives in laparoscopic complete mesocoloic excision of splenic flexure cancers. Surg Endosc 32:1202–1208
Kwak HD, Ju JK, Lee SY et al (2017) A comparison of laparoscopic and open D3 lymphadenectomy for transverse colon cancer. Int J Colorectal Dis 32:1733–1739
Jung KU, Park Y, Lee KY et al (2015) Robotic transverse colectomy for mid-transverse colon cancer: surgical techniques and oncologic outcomes. J Robot Surg 9:131–136
de’Angelis N, Alghamdi S, Renda A et al (2015) Initial experience of robotic versus laparoscopic colectomy for transverse colon cancer: a matched case-control study. World J Surg Oncol 13:295
Ozben V, Aytac E, Atasoy D et al (2019) Totally robotic complete mesocolic excision for right-sided colon cancer. J Robot Surg 13:107–114
Trastulli S, Coratti A, Guarino S et al (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29:1512–1521
Tarta C, Bishawi M, Bergamaschi R (2013) Intracorporeal ileocolic anastomosis: a review. Tech Coloproctol 17:479–485
Benlice C, Stocchi L, Costedio MM et al (2016) Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 59:743–750
Perrakis A, Weber K, Merkel S et al (2014) Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Colorectal 29:1223–1229
Kotake K, Honjo S, Sugihara K et al (2012) Number of lymph nodes retrieved is an important determinant of survival of patients with stage II and stage III colorectal cancer. Jpn J Clin Oncol 42:29–35
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Ozben, V., de Muijnck, C., Sengun, B. et al. Robotic complete mesocolic excision for transverse colon cancer can be performed with a morbidity profile similar to that of conventional laparoscopic colectomy. Tech Coloproctol 24, 1035–1042 (2020). https://doi.org/10.1007/s10151-020-02249-y
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DOI: https://doi.org/10.1007/s10151-020-02249-y