Safety and efficacy of totally minimally invasive right colectomy in the obese patients: a multicenter propensity score-matched analysis

Abstract

Despite the well-known benefits of the minimally invasive approach for the right colon cancer treatment, less is known about its feasibility and advantages in morbid obese patients. The aim of this study is to compare the postoperative outcomes after totally minimally invasive right colectomy between the obese and non-obese population. Data derived from a prospectively maintained multicenter colorectal database were analysed, dividing the enrolled patients into two groups: obese (BMI > 29.99) patient group and non-obese patient group. Data about gender, age, American Society of Anesthesiologists (ASA) Score, tumor characteristics, operative time, anastomosis time, extraction site, incision length, intraoperative complications, postoperative complications, postoperative recovery, specimen length and retrieved nodes were taken to assess the achievement of the oncologic standards. After a propensity score matching, a total of 184 patients was included, 92 in each group. No differences were found in terms of demographic data and tumor characteristics. Intraoperative data showed a significant difference in terms of anastomosis time in favour of non-obese group (p < 0.0001). No intraoperative complications were recorded and no conversion was needed in both groups. No differences were found in terms of postoperative complications. There were no differences in terms of first mobilization (p = 0.745), time to first flatus (p = 0.241) time to tolerance to liquid and solid diet (p = 0.241 and p = 0.06) and length of hospital stay (p = 0.817). The analysis of oncologic outcomes demonstrated adequate results in both groups. The results obtained by our study confirmed the feasibility and safety of the totally minimally invasive approach even in obese population.

The impact of operative approach for obese colorectal cancer patients: analysis of the National Inpatient Sample 2015–2019

“…As with nonobese patients, increasing surgeon and hospital volume, as well as teaching hospital status, is likely to decrease the impact of obesity‐related technical challenges. This was found in a recent study performed at a high‐volume centre showing no differences in conversion to open surgery or incidence of intraoperative complications between obese and nonobese patients undergoing right‐sided MIS colon resections [33]. The availability of skilled operative assistants is likely to be higher in teaching hospitals and urban centres, which can be of heightened importance in this population [34].…”

Colorectal Cancer: Current Updates and Future Perspectives

“…Countries undergoing economic growth and westernization (medium HDI nations, such as Brazil, Russia, China, Latin America, the Philippines, and the Baltics) are experiencing increasing incidence of CRC. This trend reflects changes in lifestyle factors and diet: the economic development is responsible of increased consumption of red meat, fat, sugar, animal-source foods, and energy-dense food, which is associated with reduced physical activity and rising of being overweight and obese [ 46 , 47 , 48 , 49 , 50 ]. Most high-HDI nations (such as Canada, the UK, Denmark, and Singapore) have seen an increase in incidence but lowering in mortality, probably due to improved therapies.…”

Could the top-down right hemicolectomy be an easier alternative to the classic medial-to-lateral approach in obese patients? A case report with video example

“…Obesity in laparoscopy does not seem to impact the lymph node retrieval [7] , the minimally invasive procedure's feasibility and safety. Still, some objective difficulties could be found during interventions, like anastomosis time [8] . The persistent increase in obesity and simultaneous colorectal cancer implies an increase in laparoscopic procedures in these patients that surgeons need to deal with.…”