Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison
- 5 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 35 (5), 2039-2048
- https://doi.org/10.1007/s00464-020-07600-w
Abstract
Background We describe our preliminary experience in complete mesocolic excision (CME) with central vascular ligation (CVL) and intracorporeal anastomosis for right colon cancer, comparing the robotic and the three-dimensional (3D) laparoscopic approach. Methods We performed a retrospective observational clinical cohort study on patients who underwent radical curative surgical resection of right colon cancer with CME from January 2014 to June 2019. Propensity scores were calculated by bivariate logistic regression, including the following variables: age, BMI, and size of tumor. Results Fifty-five patients underwent CME with CVL: 26 by means of robot-assisted surgery and 29 by means of 3D laparoscopic procedure. There were not statistically significant differences about all the intra- and postoperative outcomes (operative time, length of the specimen, time to bowel canalization, time to soft oral intake, length of hospital stay, postoperative complication, number of retrieved lymph nodes, number of positive lymph nodes and lymph node ratio) between the robotic and the 3D laparoscopic approach. After the matching procedure, 20 patients of the robotic group and 20 patients of the 3D laparoscopic group were selected for the analysis. There were no differences in any of the analyzed variables between the two groups except for longer operative time in the robotic group (p = 0.002). Conclusion The 3D vision revealed an important advantage in order to achieve the correct identification of surgical anatomy allowing a safe and effective right colectomy with CME, CVL, and intracorporeal anastomosis, either using laparoscopic or with robotic approach, providing similar short-term outcomes. Taking into account the high costs and the longer operative time of robotic procedure, the 3D laparoscopy could be considered in performing right colectomy with CME, while the robotic approach should be considered as a first choice approach for challenging situations (obese patient, complex associated procedures).Keywords
This publication has 52 references indexed in Scilit:
- Open vs robot‐assisted laparoscopic gastric resection with D2 lymph node dissection for adenocarcinoma: a case‐control studyInternational Journal of Medical Robotics and Computer Assisted Surgery, 2011
- Multicentric Study on Robotic Tumor-Specific Mesorectal Excision for the Treatment of Rectal CancerAnnals of Surgical Oncology, 2010
- Intraoperative and Postoperative Outcome of Robot-Assisted and Traditional Laparoscopic Nissen FundoplicationEuropean Surgical Research, 2009
- Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational studyThe Lancet Oncology, 2008
- Evaluating the Degree of Difficulty of Laparoscopic Colorectal SurgeryArchives of Surgery, 2008
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studiesJournal of Clinical Epidemiology, 2008
- A Modified Umbilical Incision for Specimen Extraction After Laparoscopic Abdominal SurgerySurgical Endoscopy, 2007
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational StudiesPLoS Medicine, 2007
- Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trialThe Lancet Oncology, 2005
- Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trialThe Lancet, 2005