Robotic Versus Laparoscopic Right Hemicolectomy For Cancer

Abstract

Background: Laparoscopic right colectomy is regarded technically difficult especially with
intracorporeal anastomosis, and in obese patients. Robotic surgery may offer a solution to these
limitations. Our aim is to evaluate the results of robotic right hemicolectomy for cancer compared to
traditional laparoscopy.

Methods: Retrospective study including all patients who underwent elective laparoscopic or robotic
right hemicolectomy for cancer from January 2009 till August 2011.We analyzed the preoperative,
operative and pathological criteria, postoperative outcomes and follow up.

Results: We had 48 patients (M: F of 1.3:1), 34 laparoscopic, 14 robotic comparable as regards ASA
grade BMI and co-morbid conditions. The site of lesions were; cecum=18, ascending colon=24, hepatic
flexure=7 (one patient had 2 synchronous tumors). There were no statistically significant differences in
the total operative time or amount of blood loss or hospital stay between both groups. No open conversion
in the robotic group compared to 2 in the laparoscopic group. There was a statistically significant
difference in the number of lymph nodes retrieved; 21.1±10 in the robotic group compared to 16.4±4.8
in the laparoscopic group (P value=0.0320). In the laparoscopic group we performed extracorporeal
mechanical anastomosis in 24 cases (70%) and in the robotic group intracorporeal manual anastomosis
in 9(64%). In the laparoscopic group there were 3 anastomosis related complications: 2 bleedings and
one major leak, none in the robotic group. We had a single mortality in the laparoscopic group from
advanced disease. Short term follow up revealed no relapses in neither groups.

Conclusion: Robotic hemicolectomy for right colon cancer appears as a safe and effective technique
with less anastomosis related complications and better patient outcome with comparable oncological
results.