Robotic complete mesocolic excision with central vascular ligation for right colonic tumours – a propensity score-matching study comparing with standard laparoscopy

Khan, Jim S. and Ahmad, Anwar and Odermatt, Manfred and Jayne, David G. and Ahmad, Nasir Z. and Kandala, Ngianga and West, Nicholas P. (2021) Robotic complete mesocolic excision with central vascular ligation for right colonic tumours – a propensity score-matching study comparing with standard laparoscopy. BJS Open, 5 (2). zrab016. ISSN 2474-9842

[img]
Preview
Text
Published Version
Available under the following license: Creative Commons Attribution.

Download (560kB) | Preview
Official URL: https://doi.org/10.1093/bjsopen/zrab016

Abstract

Background: Laparoscopic complete mesocolic excision (CME) of the right colon with central vascular ligation (CVL) is a technically demanding procedure. This study retrospectively evaluated the feasibility, safety and oncological outcomes of the procedure when performed using the da Vinci® robotic system. Methods: A prospective case series was collected over 3 years for patients with right colonic cancers treated by standardized robotic CME with CVL using the superior mesenteric vessels first approach. The CME group was compared to a 2 : 1 propensity score-matched non-CME group who had conventional laparoscopic right colectomy with D2 nodal dissection. Primary outcomes were total lymph node harvest and length of specimen. Secondary outcomes were operative time, postoperative complications, and disease-free and overall survival. Results: The study included 120 patients (40 in the CME group and 80 in the non-CME group). Lymph node yield was higher (29 versus 18, P = 0.006), the specimen length longer (322 versus 260 mm, P = 0.001) and median operative time was significantly longer (180 versus 130 min, P < 0.001) with robotic CME versus laparoscopy, respectively. Duration of hospital stay was longer with robotic CME, although not significantly (median 6 versus 5 days, P = 0.088). There were no significant differences in R0 resection rate, complications, readmission rates and local recurrence. A trend in survival benefit with robotic CME for disease-free (P = 0.0581) and overall survival (P = 0.0454) at 3 years was documented. Conclusion: Robotic CME with CVL is feasible and, although currently associated with a longer operation time, it provides good specimen quality, higher lymph node yield and acceptable morbidity, with a disease-free survival advantage.

Item Type: Journal Article
Keywords: postoperative complications, colonic neoplasms, tissue dissection, education, medical, continuing, laparoscopy, ligation, mesentery, patient readmission, safety, surgical procedures, operative lymph nodes, morbidity, colon cancer, ascending colon, excision, lapar
Faculty: Faculty of Health, Education, Medicine & Social Care
Depositing User: Lisa Blanshard
Date Deposited: 29 Apr 2021 10:30
Last Modified: 09 Sep 2021 18:51
URI: https://arro.anglia.ac.uk/id/eprint/706537

Actions (login required)

Edit Item Edit Item