Robotic‐assisted colectomy for right‐sided colon cancer: Short‐term surgical outcomes of a multi‐institutional prospective cohort study in Japan

Abstract

BackgroundIn Japan, there are no substantial reports on robotic‐assisted colectomy because few institutions performed the procedure, as it was not covered by national insurance until March 2022.AimThis study aimed to evaluate the safety and feasibility of robotic‐assisted colectomy for patients with curatively resectable colon cancer in Japan.MethodsThis multi‐institutional, prospective, single‐arm, observational study enrolled patients diagnosed with curatively resectable clinical stage I–IIIC colon adenocarcinoma with D2 or D3 lymph node dissection and treated with robotic‐assisted colectomy. The primary endpoint was the conversion rate to laparotomy. The non‐inferiority of outcomes for robotic‐assisted colectomy versus laparoscopic colectomy, which was determined from historical data, was verified.ResultsOne hundred patients were registered between July 2019 and March 2022 and underwent robotic‐assisted colectomy performed by seven expert surgeons at six institutions. Thirteen patients were excluded because their surgeons had insufficient experience performing robotic‐assisted colectomy; therefore, 87 patients were eligible for the primary endpoint analysis. There was no conversion in these 87 patients, and robotic‐assisted colectomy was non‐inferior to laparoscopic colectomy in terms of conversion rate (90% confidence interval 0–3.38, p = 0.0006). No intraoperative adverse events occurred, and no mortality was observed in a total of 100 patients. The rate of patients with Clavien–Dindo complications grade III or higher was 4%.ConclusionThis study showed the non‐inferiority of the conversion rates between robotic‐assisted colectomy and laparoscopic colectomy. Favorable perioperative outcomes also suggest the safety and feasibility of robotic‐assisted colectomy.

Surgical outcomes of a prospective, phase 2 trial of robotic surgery for resectable right‐sided colon cancer (the ROBOCOLO trial)

“…28 There has been only one report in Japan to date, showing Clavien-Dindo grade II or higher morbidity of 11%, grade III morbidity of 4% and no mortality after Ro-RC for right-sided colon cancer. 11 In this study, the morbidity of Clavien-Dindo grade II or higher was 7.6%, grade III was 0%, and there was no mortality, similar to previously reported results.…”

“…Currently, Ro-RC is gradually expanding in Japan, but only one prospective clinical trial has been reported to date. 11 In this prospective phase II study, we evaluated the safety of Ro-RC in the introduction phase.…”

A case of robot‐assisted resection for cecum cancer with anomalous venous confluence

“…However, robotic surgery has been reported to prolong the operative time in comparison to laparoscopic surgery 1 . In particular, robotic surgery for colon cancer has been reported to be non‐inferior to laparoscopic surgery in terms of the open conversion rate 8 . The benefits of robotic surgery may be fully realized in cases with vascular anomalies, such as in the present case.…”

“…The use of robot‐assisted surgery for colon cancer is increasing. Outcomes of robotic surgery for colon cancer are reportedly comparable to those of laparoscopy 1,7,8 . Laparoscopic surgery is the most commonly performed surgery for colorectal cancer.…”

A first report of right-hemicolectomy for ascending colon cancer in Japan with the da Vinci SP surgical robot system

“…In Japan, robotic surgery for rectal resection was covered by insurance in 2018, whereas that for colon cancer surgery was covered in 2022, and such coverage is expected to spread to other medical conditions with the increasing societal need for minimally invasive surgery. In Japan, a prospective cohort study on robotic surgery for colon cancer demonstrated the safety and curative potential of the surgical system [ 3 ]. The world's first minimally invasive single-incision laparoscopic surgery (SLS) was reported in 2008 [ 4 ], and many studies have shown its safety and favorable oncologic outcomes compared with those of multiport laparoscopic surgery [ 5 – 8 ].…”