Robotic assistance in right hemicolectomy is safe and feasible but is associated with a longer operative time and, at present, with a higher cost compared with laparoscopy. However, right hemicolectomy serves as an ideal procedure to begin the learning curve in robotic colorectal surgery, which can subsequently progress to robotic rectal resections where the robot has the greatest potential for benefit.

Colorectal cancer (CRC) is a common cancer worldwide with a low reported incidence in India. There is significant geographical variation in the incidence rates, and the presentation may also vary. There are few studies evaluating the clinical profile of CRC in Indian patients. We analyzed a prospective database maintained at the Tata Memorial Hospital, a referral cancer center in Mumbai, of consecutive patients with CRC between August 2013 and August 2014. We captured details regarding the demography, symptoms, pathology, stage, and treatment plan. The aim was to assess the demographic and clinical details of patients with CRC in India and compare it with those of the reported literature. Eight hundred new patients with CRC were seen in the colorectal clinic in one year. The mean age was 47.2 years. Sixty-five percent were males. Patients were symptomatic for an average period of 4 months prior to presentation. The commonest symptoms were rectal bleeding (57%), pain (44%), and altered bowel habits (26%). Thirteen percent of the patients had signet ring tumors. The median CEA (carcinoembryonic antigen) level was 5.8 ng/mL. Most patients had localized or locally advanced disease. Twenty-eight percent of the patients had metastatic disease with liver being the commonest site of metastases (14%) followed by peritoneum and lung. More than half of the patients received treatment with a curative intent. Colorectal cancer in India differs from that described in the Western countries. We had more young patients, higher proportion of signet ring carcinomas, and more patients presenting with an advanced stage. Inadequate access to healthcare and socioeconomic factors may play a role in some of these differences.

A Pfannenstiel incision is associated with the lowest rate of incisional hernia and should be the incision of choice for hand assistance and specimen extraction in minimally invasive colorectal resections wherever applicable.

This series compares favorably with similar published reports with regard to the safety and feasibility of robotic assistance in total mesorectal excision for rectal cancer. The lower conversion rates reported for robotic rectal resection compared with laparoscopy require validation in large randomized trials.

Robotic colon and rectal resections are safe and feasible options for the treatment of both benign and malignant disease processes. Further studies comparing oncologic and perioperative outcomes of robotic, laparoscopic, and open techniques are needed to determine the utility and efficacy of this technology in the field of colorectal surgery.

Robotic total mesorectal excision is feasible and safe, and is comparable to open total mesorectal excision in terms of perioperative and pathological outcomes. The longer operative time associated with robotic total mesorectal excision could decrease as experience with this relatively new technique increases. Large randomized trials are necessary to validate the potential benefits of less blood loss and lower margin positivity rates observed in this study.

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The extent of resection for proximal third gastric cancer does not influence the clinical outcome. PG and TG have similar survival rates. Both procedures can be accomplished safely. Therefore, PG should be an alternative to TG, even in locally advanced proximal gastric cancers treated by NACT, provided that the tumor size and location permit preservation of adequate remnant of stomach without compromising oncological resection margins. Future QOL studies would further lend credence to the concept of PG for proximal third gastric cancer.