Robotic complete mesocolic excision and central vascular ligation for right‐sided colon cancer: short‐term outcomes from a case series

• Published in: ANZ journal of surgery Vol. 91; no. 1-2; pp. 117 - 123
• Main Authors: Larach, José T., Rajkomar, Amrish K. S., Narasimhan, Vignesh, Kong, Joseph, Smart, Philip J., Heriot, Alexander G., Warrier, Satish K.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-01-2021; Blackwell Publishing Ltd
• Subjects: Adenocarcinoma; Aged; Aged, 80 and over; Antibiotics; Body mass; Body mass index; Body size; Cancer; Colectomy; Colon; Colon cancer; Colonic Neoplasms - surgery; Colorectal cancer; complete mesocolic excision; Complications; D3 lymphadenectomy; Demographic variables; Female; Humans; Intravenous administration; Laparoscopy; Ligation; Lymph Node Excision; Lymph nodes; Lymphatic system; Mesocolon - surgery; Patients; right hemicolectomy; robotic colectomy; Robotic surgery; Robotic Surgical Procedures; Surgery; D3 lymphadenectomy; right hemicolectomy; complete mesocolic excision; robotic colectomy; colon cancer
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.16224

This study aims to report the safety profile of complete mesocolic excision and central vascular ligation in patients undergoing robotic surgery for right‐sided colon cancer during the introduction of this technique across two institutions in Australia. This series of 20 patients demonstrates a safe introduction of robotic complete mesocolic excision and central vascular ligation in patients with right‐sided colon cancer, without Clavien III or more complications and no reinterventions. All patients had a complete resection and the lymph node harvest was high in this setting.
Background
Despite conflicting data regarding oncological outcomes, studies demonstrate that complete mesocolic excision (CME) and central vascular ligation (CVL) for right‐sided colon cancer removes significantly more tissue and yields higher lymph node counts when compared to conventional resection. This study aims to report the safety profile of CME and CVL in patients undergoing robotic surgery for right‐sided colon cancer during the introduction of this technique across two institutions.
Methods
Patients who underwent an elective robotic right colectomy with CME and CVL for right‐sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and April 2020 were included. Demographic, clinical, perioperative and histopathological variables were recorded and analysed.
Results
Twenty patients (13 females) with a median age of 69 (23–83) years and median body mass index of 27 (19–46) were included. All of them had a pre‐operative diagnosis of right‐sided colon adenocarcinoma. Median operative time and blood loss were 140 (130–300) min and 30 (20–100) mL, respectively. There were no conversions or intra‐operative complications. There were two post‐operative complications recorded (one ileus and one intra‐abdominal collection treated with intravenous antibiotics) and no re‐interventions. Median length of stay was 4 (2–8) days. All patients had an R0 resection, and the median lymph node yield was 36 (22–80) lymph nodes.
Conclusion
This series demonstrates a safe introduction of robotic CME and CVL in patients with right‐sided colon cancer. The lymph node harvest obtained with CME and CVL in this setting was high.