Initial experience of robotic versus laparoscopic colectomy for transverse colon cancer: a matched case-control study

Abstract

BackgroundRobotic surgery for transverse colon cancer has rarely been described. This study reports our initial experience in robotic resection for transverse colon cancer, by comparing robotic transverse colectomy (RC) to laparoscopic transverse colectomy (LC) in terms of safety, feasibility, short-term outcomes, and the surgeon’s psychological stress and physical pain.MethodsThe study population included the first 22 consecutive patients who underwent RC between March 2013 and December 2014 for histologically confirmed transverse colon adenocarcinoma. These patients were compared with 22 matched patients undergoing LC between December 2010 and February 2013. Patients were matched based on age, gender, body mass index (BMI), American Society of Anesthesiology (ASA) score, American Joint Committee on Cancer (AJCC) tumor stage, and tumor location (ratio 1:1). Mortality, morbidity, operative, and short-term oncologic outcomes were compared between groups. The operating surgeon’s stress and pain were assessed before and after surgery on a 0–100-mm visual analog scale.ResultsThe demographic and preoperative characteristics were comparable between RC and LC patients. No group difference was observed for intraoperative complications, blood loss, postoperative pain, time to flatus, time to regular diet, and hospital stay. RC was associated with longer operative time than LC (260 min vs. 225 min; p = 0.014), but the overall operative and robotic time in the RC group decreased over time reflecting the increasing experience in performing this procedure. No conversion to laparotomy was observed in the RC group, while two LC patients were converted due to uncontrolled bleeding and technically difficult middle colic pedicle dissection. Postoperative complications (Dindo-Clavien grade I or II) occurred in 11.3 % of patients with no group difference. Mortality was nil. All resections were R0, with >12 lymph nodes harvested in 90.9 % of RC and 95.5 % of LC patients. The surgeon’s stress was not different between RC and LC, whereas the surgeon’s hand and neck/shoulder pain were significantly lower after RC.ConclusionsRC for transverse colon cancer appears to be safe and feasible with short-term outcomes comparable to LC.

Comparison of perioperative and short-term outcomes between robotic and conventional laparoscopic surgery for colonic cancer: a systematic review and meta-analysis

“…Table 1 shows the characteristics of the included studies [ 17 18 19 20 21 22 ]. The six studies included 684 patients: 253 in the RS group and 431 in the CLS group.…”

“…Five studies [ 17 18 19 20 22 ] analyzed the time to first flatus. The pooled estimates using a fixed effects model revealed that the time was significantly shorter for RS than for CLS (MD, -0.44 days; 95% CI, -0.66 to -0.23), with no heterogeneity among the studies (P = 0.050, I 2 = 55%) ( Table 2 , Fig.…”

Robotic versus laparoscopic distal pancreatectomy – The first meta-analysis

“…It was reported that the docking time of the robot was 30 min. 18 Taking into account that the docking time was included in the total operative time, there is no essential difference between the two procedures. As with any surgical innovation, the operative time of the robotic interventions not only depended on the surgeon's skills and their stage of the learning curve, but also on institutional learning curves as well.…”

Robotic-Assisted Versus Laparoscopic Colectomy Results in Increased Operative Time Without Improved Perioperative Outcomes

“…In a small series of 44 patients undergoing transverse colectomy for adenocarcinoma, robotic-assisted surgery was equivalent to laparoscopic surgery in terms of postoperative complications, length of stay, blood loss, pain, and return to bowel function and regular diet. 26 Robotic-assisted and laparoscopic left and sigmoid colectomy have had comparable outcomes in small institutional series. 27 , 28 For total abdominal colectomy, robotic-assisted surgery has been shown to have similar morbidity and mortality as compared to laparoscopic surgery.…”