| Contributors: |
De'Angelis, N.; Schena, C. A.; Espin-Basany, E.; Piccoli, M.; Alfieri, S.; Aisoni, F.; Coccolini, F.; Frontali, A.; Kraft, M.; Lakkis, Z.; Leroy, B.; Luzzi, A. P.; Milone, M.; Pattacini, G. C.; Pellino, G.; Petri, R.; Piozzi, G. N.; Quero, G.; Ris, F.; Winter, D. C.; Khan, J.; Pecchini, F.; O'Connell, L.; Carcoforo, P.; Paquet, J. -C.; Urbani, A.; Tartaglia, D.; Chiarugi, M.; Arces, F.; Denet, C.; Ortenzi, M.; Vidal, L.; Antonot, C.; Vertier, J.; Perrotto, O.; De Palma, G. D.; Santangelo, A.; De Rosa, R.; Romairone, E.; Ribeca, U. G.; Restivo, A.; Deidda, S.; Orci, L.; Bartoletti, S.; Andolfi, E.; Di Saverio, S.; Bianchi, G.; Genova, P.; Guerrieri, M.; Micelli Lupinacci, R.; Scabini, S.; Tonini, V.; Valverde, A.; Zorcolo, L.; Fuks, D.; Celentano, V.; Fiorillo, C.; De Sio, D.; Martinez-Perez, A.; Marchegiani, F. |
| Description: |
Aim: Minimally invasive surgery has been increasingly adopted for locally advanced colon cancer. However, evidence comparing robotic (RRC) versus laparoscopic right colectomy (LRC) for nonmetastatic pT4 cancers is lacking. Methods: This was a multicentre propensity score-matched (PSM) study of a cohort of consecutive patients with pT4 right colon cancer treated with RRC or LRC. The two surgical approaches were compared in terms of R0, number of lymph nodes harvested, intra- and postoperative complication rates, overall (OS), and disease-free survival (DFS). Results: Among a total of 200 patients, 39 RRC were compared with 78 PS-matched LRC patients. The R0 rate was similar between RRC and LRC (92.3% vs. 96.2%, respectively; p = 0.399), as was the odds of retrieving 12 or more lymph nodes (97.4% vs. 96.2%; p = 1). No significant difference was noted for the mean operating time (192.9 min vs. 198.3 min; p = 0.750). However, RRC was associated with fewer conversions to laparotomy (5.1% vs. 20.5%; p = 0.032), less blood loss (36.9 vs. 95.2 mL; p < 0.0001), fewer postoperative complications (17.9% vs. 41%; p = 0.013), a shorter time to flatus (2 vs. 2.8 days; p = 0.009), and a shorter hospital stay (6.4 vs. 9.5 days; p < 0.0001) compared with LRC. These results were confirmed even when converted procedures were excluded from the analysis. The 1-, 3- and 5-year OS (p = 0.757) and DFS (p = 0.321) did not significantly differ between RRC and LRC. Conclusion: Adequate oncological outcomes are observed for RRC and LRC performed for pT4 right colon cancer. However, RRC is associated with lower conversion rates and improved short-term postoperative outcomes. |