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Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison

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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).

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Abbreviations

CME:

Complete mesocolic excision

CVL:

Central vascular ligation

TME:

Total mesorectal excision

NET:

Neuroendocrine tumor

OS:

Overall survival

DFS:

Disease-free survival

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Authors and Affiliations

  1. General Surgery, San Giovanni Battista” Hospital, USL Umbria 2, Via Massimo Arcamone, 1, 06034, Foligno, PG, Italy

    Graziano Ceccarelli, Michele De Rosa, Fabio Rondelli & Walter Bugiantella

  2. Emergency Surgery Unit, “Sant’Andrea” Hospital, Sapienza” University of Rome, Via di Grottarossa, 1035, 00189, Roma, Italy

    Gianluca Costa

  3. Department of Biomedical Sciences and Human Oncology – Unit Of Endocrine, Digestive And Emergency Surgery, Policlinic of Bari, University “A. Moro” of Bari, Piazza Giulio Cesare, 1, 70124, Bari, Italy

    Valentina Ferraro

  4. Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy

    Fabio Rondelli

  5. General Surgery, ASL Toscana Sud-Est, San Donato” Hospital, Via Pietro Nenni, 1, 52100, Arezzo, Italy

    Graziano Ceccarelli

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  1. Graziano Ceccarelli
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  2. Gianluca Costa
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  4. Michele De Rosa
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  6. Walter Bugiantella
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Correspondence to Walter Bugiantella.

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Graziano Ceccarelli, Gianluca Costa, Valentina Ferraro, Michele De Rosa, Fabio Rondelli, and Walter Bugiantella have no conflicts of interest or financial ties to disclose.

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Ceccarelli, G., Costa, G., Ferraro, V. et al. Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison. Surg Endosc 35, 2039–2048 (2021). https://doi.org/10.1007/s00464-020-07600-w

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