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. 2021 Dec;35(12):6873-6881.
doi: 10.1007/s00464-020-08194-z. Epub 2021 Jan 5.

Robotic Complete Mesocolic Excision (CME) is a safe and feasible option for right colonic cancers: short and midterm results from a single-centre experience

Najaf Siddiqi  1   2 , Samuel Stefan  1   2 , Ravish Jootun  1 , Ioannis Mykoniatis  1 , Karen Flashman  1 , Richard Beable  1 , Gerald David  1 , Jim Khan  3   4
Affiliations

Robotic Complete Mesocolic Excision (CME) is a safe and feasible option for right colonic cancers: short and midterm results from a single-centre experience

Najaf Siddiqi et al. Surg Endosc. 2021 Dec.

Abstract

Background: Complete mesocolic excision (CME) for right colon cancers has traditionally been an open procedure. Surgical adoption of minimal access CME remains limited due to the technical challenges, training gaps and lack of level-1 data for proven benefits. Currently there is limited published data regarding the clinical results with the use of robotic CME surgery. Aim To report our experience, results and techniques, highlighting a clinical and oncological results and midterm oncological outcomes for robotic CME.

Aim: To report our experience, results and techniques, highlighting a clinical and oncological results and midterm oncological outcomes for robotic CME.

Methods: All patients undergoing standardised robotic CME technique with SMV first approach between January 2015 and September 2019 were included in this retrospective review of a prospectively collected database. Patient demographics, operative data and clinical and oncological outcomes were recorded.

Results: Seventy-seven robotic CME resections for right colonic cancers were performed over a 4-year period. Median operative time was 180 (128-454) min and perioperative blood loss was 10 (10-50) ml. There were 25 patients who had previous abdominal surgery. Median postoperative hospital stay was 5 (3-18) days. There was no conversion to open surgery in this series. Median lymph node count was 30 (10-60). Three (4%) patients had R1 resection. There was one (1%) local recurrence in stage III disease and 4(5%) distal recurrence in stage II and stage III. There was no 30- or 90-day mortality. Three-year disease-free survival was 100%, 91.7% and 92% for stages I, II and III, respectively. Overall survival was 94%.

Conclusions: Robotic CME is feasible, effective and safe. Good oncological results and improved survival are seen in this cohort of patients with a standardised approach to robotic CME.

Keywords: Complete Mesocolic Excision; Right colon cancer; Robotic surgery; Techniques.

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Conflict of interest statement

Jim Khan: Trainer and proctor with Intuitive Surgical and Johnson & Johnson. Najaf N. Siddiqi, Sam Stefan, Ravish Jootun, and Gerald David have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
A and B Oblique and suprapubic port placement for Davinci system X
Fig. 2
Fig. 2
Operating room layout for CME
Fig. 3
Fig. 3
Origin of Ileocolic artery and vein
Fig. 4
Fig. 4
Middle colic artery dividing into right and left branches
Fig. 5
Fig. 5
Trunk of Henle originating from SMV
Fig. 6
Fig. 6
Blood loss and operating time scatter plot with the number of cases
Fig. 7
Fig. 7
a Disease-free survival for robotic CME for colon cancer. b Overall survival for robotic CME for colon cancer
Fig. 8
Fig. 8
Overall and disease-free survival for robotic CME for colon cancer for stages I, II and III
See this image and copyright information in PMC

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