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

Waters, Peadar S; Cheung, Francis; Peacock, Oliver; Heriot, Alexander G.; Warrier, Satish; Ó’Ríordáin, D. S.; Pillinger, Stephen H.; Lynch, A. C.; Stevenson, Andrew

doi:10.1111/codi.14822

Cited by 51 publications

(72 citation statements)

References 48 publications

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“…Dear Editor, We have read with great interest the paper 'Quality of life with or without sphincter preservation for rectal cancer' [1]. Feddern et al suggest an improved quality…”

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confidence: 99%

Reply to Slim et al.

et al. 2019

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deserves some comments. First, this is not a quantitative review, while the authors had, in my opinion, sufficient data for pooling the results and doing a formal metaanalysis. The authors concluded that the patients undergoing robotic right colectomy had fewer anastomotic complications, better lymph node harvest, and reduced conversion rate and length of stay in 'a number of studies'. This conclusion does not appear to be in line with their published results, and it is somewhat misleading. The better lymph node harvest was reported in only two studies (of 14), and the lower anastomotic leak was reported in only one study (of 10). Furthermore, one cannot exclude confounding factors related to the anastomotic technique in this study [2]. The difference could be related to the use of an intracorporeal anastomosis rather than the robot. Regarding the length of stay, as everyone knows, this is a very subjective item that can be the result of several non-surgical factors. Furthermore, we do not know whether these patients benefitted or not from an enhanced recovery programme [3]. Finally, in terms of evidence based medicine, there is one randomized trial published in 2012 on this topic [4]. This trial showed no benefit from the robotic approach, therefore not justifying its greater cost. A recent metaanalysis confirmed this lack of a clear benefit [5]. Obviously, for the purists, a large randomized controlled trial is preferable to give a definitive answer. But one can ask, knowing the higher cost of robotic surgery for colectomy and the lack of benefits from the patients' perspective, do we really need a further randomized trial on robotic colectomy?

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“…Dear Editor, We have read with great interest the paper 'Quality of life with or without sphincter preservation for rectal cancer' [1]. Feddern et al suggest an improved quality…”

Section: Dear Editormentioning

confidence: 99%

Reply to Slim et al.

et al. 2019

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“…Conversion rates in randomized controlled trials comparing laparoscopic with other approaches colectomy ranged from 0% to 18.1% [25][26] . The cause of conversion in laparoscopic colectomy for cancer included tumor invasion, abdominal adhesions, intraoperative bleeding, anatomical complexity and so on [27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

The tunnel approach versus medial approach in laparoscopic radical right hemicolectomy for colon cancer: A retrospective cohort study

zhang¹,

Zhang²,

Ma³

et al. 2020

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Background: Although Multiple studies showed that the median approach is nowadays the most widely accepted approach according to the “no-touch” principle and safety. However, this approach is a demanding procedure with a steep learning curve and has a high rate of conversion to laparotomy. This aim is to explore the feasibility and safety of tunnel approach in laparoscopic radical right hemicolectomy for colon cancer.Methods：From July 2016 to October 2018, a total of 106 consecutive patients with colon cancer who were subjected to the laparoscopic radical right hemicolectomy in the affiliated cancer hospital of zhengzhou university were enrolled. The patients underwent either tunnel approach (TA) (n=56) or traditional medial approach (MA) (n=50) according to the surgical maneuver performed. The patients' baseline demographics and perioperative results were compared between the two groups.Results: The baseline characteristics did not differ between groups. The blood loss was significantly less [20.0(5.0-40.0) vs. 100(50.0-150.0) , p < 0.001] and operation time was significantly shorter [128.4±16.7 vs. 145.6±20.3min, p < 0.001]in the TA group than those in MA group. Time to first flatus and postoperative hospital stay were similar [3.0(2.0-4.0) vs. 3.0(3-4.0)d，p=0.329; 10.4±2.6 vs. 10.7±3.0d，p=0.506] in both groups. The conversion to laparotomy and complication rates were similar between the groups(0 vs. 6.0%, p = 0.203; 14.3% vs. 18.0%, p =0.603,respectively). There was no treatment-related death in both groups.Conclusions: The tunnel approach in laparoscopic radical right hemicolectomy for colon cancer is a technically feasible and safe procedure as a preferable approach at present compared to those of medial approach, meanwhile this method is easier for beginners to master. Hence this tunnel approach right hemicolectomy is worth recommended.

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“…Dear Editor, Oncological outcomes of laparoscopic resections for T4 colon cancer have not shown any significant difference between comparative observational studies and open surgery, although the risk of developing postoperative complications was significantly lower with a minimally invasive approach [1,2]. However, some multivisceral resections may be technically challenging.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

Robotic right hemicolectomy and partial nephrectomy for synchronous malignancies – a video vignette

2020

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Multiple abdominal and perineal approaches have been described for the treatment of full-thickness rectal prolapse. There has been no consensus on the optimal approach, with randomized controlled trials and metaanalysis failing to show superiority of any particular approach [1,2]. Recently, use of the laparoscopic abdominal approach has increased, although this technique may not be suitable for all patients [3]. The Delorme's procedure is useful for treating rectal prolapse in elderly patients with significant comorbidities, patients at high risk for general anaesthesia and patients with recurrence after an abdominal procedure [4,5]. We describe the steps of the procedure in a 65-yearold man with a recurrent rectal prolapse (Video S1). The procedure can be performed under general or spinal anaesthesia, with the patient in the lithotomy position. Use of a headlight is advisable. The prolapse is reproduced to assess the length of mucosectomy required (double the length of the prolapse). After application of a Lone Star retractor (Cooper Surgical, Trumbull, CT, USA), the dentate line is visualized and the mucosa marked circumferentially 2 cm proximally. The submucosa is infiltrated with a saline/ adrenaline solution (1:100 000) and incised circumferentially. A mucosal sleeve is developed, with care being taken not to buttonhole the mucosa or the muscle. This is followed by plication of the muscle with 2-0 or 3-0 Polydioxanone and mucosal approximation with 3-0 polygalactin. Our patient made an uneventful recovery and was recurrence-free 10 months after the procedure. The Delorme's procedure can be a valuable tool for treating a select group of patients with rectal prolapse. A stepwise approach helps to standardize the procedure and reduces intra-operative complications and postoperative morbidity.

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

Cited by 51 publications

References 48 publications

Reply to Slim et al.

Reply to Slim et al.

The tunnel approach versus medial approach in laparoscopic radical right hemicolectomy for colon cancer: A retrospective cohort study

Robotic right hemicolectomy and partial nephrectomy for synchronous malignancies – a video vignette

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