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Comparative Study
. 2024 Aug;26(8):1569-1583.
doi: 10.1111/codi.17089. Epub 2024 Jul 8.

Robotic versus laparoscopic right colectomy for nonmetastatic pT4 colon cancer: A European multicentre propensity score-matched analysis

Nicola de'Angelis  1   2 , Carlo Alberto Schena  1   3 , Eloy Espin-Basany  4 , Micaela Piccoli  5 , Sergio Alfieri  3 , Filippo Aisoni  6 , Federico Coccolini  7 , Alice Frontali  8 , Miquel Kraft  4 , Zaher Lakkis  9 , Bertrand Le Roy  10 , Andrea Pierre Luzzi  11 , Marco Milone  12 , Gianmaria Casoni Pattacini  5 , Gianluca Pellino  4 , Roberto Petri  13 , Guglielmo Niccolò Piozzi  14 , Giuseppe Quero  3 , Frederic Ris  15 , Des C Winter  16 , Jim Khan  14   17 ; MERCY Study Collaborating Group Members
Collaborators, Affiliations
Comparative Study

Robotic versus laparoscopic right colectomy for nonmetastatic pT4 colon cancer: A European multicentre propensity score-matched analysis

Nicola de'Angelis et al. Colorectal Dis. 2024 Aug.

Abstract

Aim: Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for nonmetastatic pT4 cancers is lacking.

Methods: This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS).

Results: Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC.

Conclusion: Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes.

Keywords: T4 cancer; locally advanced colon cancer; minimally invasive surgery; propensity score matching; right colon cancer; robotic surgery.

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References

REFERENCES

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