Skip to main content

Advertisement

SpringerLink
Log in

Robotic versus laparoscopic right colectomy within a systematic ERAS protocol: a propensity-weighted analysis

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

The purpose of this study is to compare the early postoperative and pathological outcomes of robotic right colectomy (RRC) to those of laparoscopic right colectomy (LRC) with intracorporeal anastomosis (IA) within the systematic application of an enhanced recovery after surgery (ERAS) program. A single-institution prospective database of patients who underwent elective RRC or LRC with IA for neoplastic lesions between April 2010 and June 2018 was retrospectively reviewed. The patients’ demographic characteristics, and perioperative and pathological outcomes were analyzed. Propensity-weighted analysis was employed to address potential selection biases of treatment allocation. A total of 216 patients (46 RRC, 170 LRC) were included. RRC demonstrated a significantly longer operative time (mean 242.43 min, SD 47.51) compared to LRC (mean 187.60 min, SD 56.60) (p = 0.001), confirmed by the propensity-weighted analysis (Coefficient 50.65; p < 0.001). Conversion rate between the two groups was comparable (p = 0.99). Median length of hospital stay (LOS) was the same in the RRC and the LRC group (4 days, p = 0.35). Readmission rate within 30 days in the RRC and LRC group was 2.2% and 2.4%, respectively (p = 0.99). Overall 30-day morbidity and 30-day mortality was 32.6% versus 27.1% (p = 0.46), and 0% versus 1.2% (p = 0.99) in the robotic and laparoscopic groups, respectively. No difference was found in the number of harvested lymph nodes (p = 0.75). In an ERAS environment, without the bias of mixed techniques of anastomosis, RRC had similar postoperative and pathological outcomes compared to the laparoscopic approach, but was associated with a longer operative time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991:144–150

    Google Scholar 

  2. Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303

    Article  Google Scholar 

  3. Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662

    Article  Google Scholar 

  4. Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 10:44–52

    Article  Google Scholar 

  5. Jayne DG, Thorpe HC, Copeland J et al (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645

    Article  CAS  Google Scholar 

  6. Jamali FR, Soweid AM, Dimassi H et al (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767

    Article  Google Scholar 

  7. Vignali A, Bissolati M, De Nardi P et al (2016) Extracorporeal vs. intracorporeal ileocolic stapled anastomoses in laparoscopic right colectomy: an interim analysis of a randomized clinical trial. J Laparoendosc Adv Surg Tech A. 26:343–348

    Article  Google Scholar 

  8. Wu Q, Jin C, Hu T et al (2017) Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 27(4):348–357

    Article  Google Scholar 

  9. van Oostendorp S, Elfrink A, Borstlap W et al (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31:64–77

    Article  Google Scholar 

  10. Zhang X, Wei Z, Bie M et al (2016) Robot-assisted versus laparoscopic-assisted surgery for colorectal cancer: a meta-analysis. Surg Endosc 30:5601–5614

    Article  Google Scholar 

  11. Lujan HJ, Plasencia G, Rivera BX et al (2018) Advantages of robotic right colectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech. 28:36–41

    Article  Google Scholar 

  12. Weber PA, Merola S, Wasielewski A et al (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 45:1689–1694

    Article  Google Scholar 

  13. Solaini L, Bazzocchi F, Cavaliere D et al (2018) Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 32:1104–1110

    Article  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. Park JS, Choi GS, Park SY et al (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99:1219–1226

    Article  CAS  Google Scholar 

  16. Rondelli F, Balzarotti R, Villa F et al (2015) Is robot-assisted laparoscopic right colectomy more effective than the conventional laparoscopic procedure? A meta-analysis of short-term outcomes. Int J Surg. 18:75–82

    Article  Google Scholar 

  17. Tyler JA, Fox JP, Desai MM et al (2013) Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rectum 56:458–466

    Article  Google Scholar 

  18. Solaini L, Cavaliere D, Pecchini F et al (2019) Robotic versus laparoscopic right colectomy with intracorporeal anastomosis: a multicenter comparative analysis on short-term outcomes. Surg Endosc 33:1898–1902

    Article  Google Scholar 

  19. Ngu JC, Ng YY (2018) Robotics confers an advantage in right hemicolectomy with intracorporeal anastomosis when matched against conventional laparoscopy. J Robot Surg. 12:647–653

    Article  Google Scholar 

  20. Blumberg D (2019) Robotic colectomy with intracorporeal anastomosis is feasible with no operative conversions during the learning curve for an experienced laparoscopic surgeon developing a robotics program. J Robot Surg 13:545–555

    Article  Google Scholar 

  21. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641

    Article  Google Scholar 

  22. Basse L, Thorbol JE, Lossl K et al (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277

    Article  Google Scholar 

  23. Spanjersberg WR, van Sambeeck JD, Bremers A (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453

    Article  CAS  Google Scholar 

  24. Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS((R))) society recommendations: 2018. World J Surg 43:659–695

    Article  CAS  Google Scholar 

  25. Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875

    Article  Google Scholar 

  26. Kennedy RH, Francis EA, Wharton R et al (2014) Multicenter randomized controlled trial of conventional versus laparoscopic surgery for colorectal cancer within an enhanced recovery programme: EnROL. J Clin Oncol 32:1804–1811

    Article  Google Scholar 

  27. Currie AC, Malietzis G, Jenkins JT et al (2016) Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer. Br J Surg 103:1783–1794

    Article  CAS  Google Scholar 

  28. Vather R, Bissett I (2013) Management of prolonged post-operative ileus: evidence-based recommendations. ANZ J Surg 83:319–324

    Article  Google Scholar 

  29. 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 240:205–213

    Article  Google Scholar 

  30. Le Voyer TE, Sigurdson ER, Hanlon AL et al (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919

    Article  Google Scholar 

  31. Davis BR, Yoo AC, Moore M et al (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. Jsls. 18:211–224

    Article  Google Scholar 

  32. Ma S, Chen Y, Chen Y et al (2019) Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: a systematic review and meta-analysis. Asian J Surg. 42:589–598

    Article  Google Scholar 

  33. Agenzia Nazionale per i Servizi Sanitari Regionali (2017) Piano Nazionale Esiti Ed. http://pne2017.agenas.it/. Accessed 30 Nov 2019

  34. Ni X, Jia D, Chen Y et al (2019) Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal cancer surgery? A meta-analysis of randomized controlled trials. J Gastrointest Surg. 23:1502–1512

    Article  Google Scholar 

  35. Tsikitis VL, Holubar SD, Dozois EJ et al (2010) Advantages of fast-track recovery after laparoscopic right hemicolectomy for colon cancer. Surg Endosc 24:1911–1916

    Article  Google Scholar 

  36. Nelson G, Kiyang LN et al (2016) Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS alberta colorectal surgery experience. World J Surg 40:1092–1103

    Article  Google Scholar 

  37. deSouza AL, Prasad LM, Park JJ et al (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53:1000–1006

    Article  Google Scholar 

  38. Stein SA, Bergamaschi R (2013) Extracorporeal versus intracorporeal ileocolic anastomosis. Tech Coloproctol 17(Suppl 1):S35–S39

    Article  Google Scholar 

  39. Spinoglio G, Bianchi PP, Marano A et al (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

    Article  Google Scholar 

  40. Alhassan N, Yang M, Wong-Chong N et al (2019) Comparison between conventional colectomy and complete mesocolic excision for colon cancer: a systematic review and pooled analysis : a review of CME versus conventional colectomies. Surg Endosc 33:8–18

    Article  Google Scholar 

  41. Park JS, Kang H, Park SY et al (2018) Long-term oncologic after robotic versus laparoscopic right colectomy: a prospective randomized study. Surg Endosc 33:2975–2981

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Mrs Anna-Maria Racca, native English speaker and professional translator, for having checked the grammar and style of the manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy

    Marco Migliore, Maria Carmela Giuffrida, Alessandra Marano, Luca Pellegrino, Giorgio Giraudo & Felice Borghi

  2. Department of Cardiac Surgery, Santa Croce e Carle Hospital, 12100, Cuneo, Italy

    Fabio Barili

Authors
  1. Marco Migliore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Carmela Giuffrida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandra Marano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luca Pellegrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgio Giraudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabio Barili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Felice Borghi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marco Migliore, Maria Carmela Giuffrida, and Fabio Barili. The first draft of the manuscript was written by Marco Migliore. Maria Carmela Giuffrida and Alessandra Marano commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Felice Borghi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Migliore, M., Giuffrida, M.C., Marano, A. et al. Robotic versus laparoscopic right colectomy within a systematic ERAS protocol: a propensity-weighted analysis. Updates Surg 73, 1057–1064 (2021). https://doi.org/10.1007/s13304-020-00722-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00722-9

Keywords

Search

Navigation