Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: A systematic review and meta-analysis

Ma, Shi-Xun; Chen, Yan; Chen, Yifeng; Guo, Tiankang; Yang, Xiongfei; Lu, Yunxia; Tian, Jinhui; Cai, Hui

doi:10.1016/j.asjsur.2018.11.002

Cited by 41 publications

(34 citation statements)

References 59 publications

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“…Moreover, the authors reported an early return to gut function in patients with ICA. With the aforementioned benefits of the robotic platform, it lends itself well to ICA formation with reduced learning curve and a decrease in overall associated complications compared to a laparoscopic approach . In this review, only one study documented a significant increase in anastomotic leaks in patients undergoing laparoscopic ECA as opposed to robotic ICA .…”

Section: Discussionmentioning

confidence: 92%

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

et al. 2019

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Aim Minimally invasive surgical approaches for cancer of the right colon have been well described with significant patient and equivalent oncological benefits. Robotic surgery has advanced in its ability to provide multi-quadrant abdominal access, leading the surgical community to widen its application outside of the pelvis to other abdominal compartments. Globally it is being realized that a patient's surgical episode of care is becoming the epicentre of cancer treatment. In order to establish the role of robotic surgery in a patient's episode of care, 'successful patient-oriented surgical' parameters in right hemicolectomy for malignancy were measured. The objective was to examine the rates of successful patient-oriented surgical outcomes in robotic right hemicolectomy (RRH) compared to laparoscopic right hemicolectomy (LRH) for cancer.Methods A systematic search of MEDLINE (Ovid: 1946-present), PubMed (NCBI), Embase (Ovid: 1966-present) and Cochrane Library was conducted using PRISMA for parameters of successful patient-oriented surgical outcomes in RRH and LRH for malignancy alone. The parameters measured included postoperative ileus, anastomotic complication, surgical wound infection, length of stay (LOS), incisional hernia rate, conversion to open, margin status, lymph node harvest and overall morbidity and mortality.Results There were 15 studies which included 831 RRH patients and 3241 LRH patients, with a median age of 62-74 years. No study analysed the concept of successful patient-oriented surgical outcomes. There was no significant difference in the incidence of postoperative ileus, with less time to first flatus in RRH (2.0-2.7 days, compared with 2.5-4.0 days, P < 0.05).Anastomotic leak rate in one study reported a significant increase in LRH compared to RRH (P < 0.05, 0% vs 8.3%). Significantly decreased LOS following RRH was outlined in six studies. One study reported a significantly higher rate of incisional hernias following LRH with extracorporeal anastomoses compared to RRH with intracorporeal anastomoses. Overall rates of conversion to open surgery were less with RRH (0%-3.9% vs 0%-18%, P < 0.001, 0.05). One study outlined significantly higher rates of incomplete resection with an open right hemicolectomy compared with minimally invasive laparoscopic and robotic resections, with positive margin rates of 2.3%, 0.9% and 0% respectively (P < 0.001). Two studies reported significantly higher lymph node harvest in RRH (P < 0.05). Overall morbidity and 30-day mortality were comparable in both approaches.Conclusion Thirty-day morbidity and mortality were comparable between the two approaches, with patients undergoing RRH having lower anastomotic complications, increased lymph node harvest, and reduced LOS, conversion to open and incisional hernia rates in a number of studies. There are limited data on surgical approach and impact on quality of life and what patients deem successful surgical outcomes. There is a further need for a randomized controlled trial examining successful patient-oriented outco...

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Section: Discussionmentioning

confidence: 92%

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

et al. 2019

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“…In contrast to other studies, operative time was no longer for RCS than LCS (4,10,(24)(25)(26)30). However, previous meta-analyses have been conducted on predominantly observational studies whereby there is a risk of misinterpretation of total procedure times and surgical times (31)(32)(33).…”

Section: Discussionmentioning

confidence: 89%

Improved perioperative outcomes and reduced inflammatory stress response in malignant robotic-assisted colorectal resections: a retrospective cohort study of 298 patients

Cuk

Simonsen

Komljen

et al. 2021

Preprint

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Background Robotic-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study's main objective was to compare short-term complications, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robotic-assisted. Methods We conducted a retrospective cohort study comparing the robotic-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume centre from May 2017 – March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response. Results Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robotic-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4–5) versus 5 days, interquartile range (4–7), p < 0.001) and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robotic-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.20, 95% confidence interval (1.04–1.40), p < 0.001). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery and surgical or medical short-term complications. Conclusion Robotic-assisted surgery is feasible and can be safely implemented for colorectal resections. The robotic-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short and long-term outcomes of robotic surgery for colorectal cancer.

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“…Torigoe et al performed an enlargement of the umbilical port to 3 cm, while Imagami et al performed a minilaparotomy to connect the incision of the upper abdomen to the umbilicus and a washing of the abdominal cavity was carried out afterwards [4,13]. Compared to laparoscopic right colectomy, robotic right colectomy was associated with improved recovery bowel function, significantly lowered oral morphine equivalent usage, decreased short-term complications, reduced estimated blood loss [14,15]. In a multicenter propensity score-matched comparison study between robotic and laparoscopic right colectomy, the intracorporeal anastomosis group had significantly longer operative times (p < 0.0001), but lower conversion to open rate (p = 0.01), shorter hospital length of stay (p = 0.02) and lower complication rate from after discharge to 30-days (p = 0.04) than the extracorporeal anastomosis group [16].…”

Section: Discussionmentioning

confidence: 99%

Robotic right colectomy in a patient with ventriculoperitoneal shunt. Report of a case

Mikaelian

Lodin

Priora

2019

International Journal of Surgery Case Reports

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Highlights Laparoscopic surgery in patients with VPS tubes was previously contraindicated. Robotic right colectomy is associated with improved recovery. No need of VPS catheter manipulation is needed in robotic surgery. The first reported case of a robotic right colectomy with an intracorporeal anastomosis in a patients with a VPS. Robotic right colectomy is safe also in patients with VPS, with short hospital stay and fast postoperative recovery.

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Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: A systematic review and meta-analysis

Cited by 41 publications

References 59 publications

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

Improved perioperative outcomes and reduced inflammatory stress response in malignant robotic-assisted colorectal resections: a retrospective cohort study of 298 patients

Robotic right colectomy in a patient with ventriculoperitoneal shunt. Report of a case

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