Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST)
Authors: Gómez Ruiz Marcos , Espin-Basany Eloy , Spinelli Antonino , Cagigas Fernández Carmen , Bollo Rodriguez Jesus , María Enriquez Navascués José , Rautio Tero , Tiskus Mindaugas ,   MIRCAST STUDY GROUP, Espin-Basany Eloy , Spinelli Antonino , Cagigas Fernández Carmen , Bollo Rodriguez Jesus , María Enriquez Navascués José , Rautio Tero , Tiskus Mindaugas , Arredondo Chaves Jorge , Simó Vicente , Pace Ugo , Maria Pinta Tarja , Persiani Roberto , Coratti Andrea , Pietro Bianchi Paolo , Luisa Petz Wanda , Jimenez Escobar Fernando , Vigorita Vincenzo , Truan Alonso Nuria , Kreisler Moreno Esther , Miguel Jimenez Gomez Luis , Valverde Alain , Romero de Diego Alejandro , Rouanet Philippe , Türler Andreas , Arroyo Antonio , Van Eetvelde Ellen , Vento Pälvi , Reina Duarte Ángel , Balik Emre , Muratore Andrea , Khan Jim , Rama Nuno , Moro-Valdezate David , Gögenur Ismail , Ocaña Jiménez Juan , Šantak Goran , Rullier Eric , A Shaikh Irshad , Coppola Roberto , Mendoza Fernando , Morelli Luca , Mann Benno , Frasson Matteo , Petropoulou Thalia , Turunen Arto , Ferrero Herrero Eduardo , Lykke Jakob , García Alonso Mauricio , Sanchez Gonzalez Javier , Mattila Anne , Mulita Francesk , Hance Julian , Trilling Bertrand , Marafante Chiara , Winny Markus , Büyükkasap Çağrı , Prós Ribas Imma , Romain Benoit , Leong Kai , Ioannidis Orestis , Marinello Franco , Di Candido Francesca , Sacchi Matteo , Foppa Caterina , Cristobal Poch Lidia , Suarez Pazos Natalia , García Cardo Juan , Lladó Jordan Gina , Palazuelos Calderón Camilo , Lavín Alconero Lucía , Castillo Diego Julio , Codina Claudia , Placer Galan Carlos , Borda Aguizabalaga Nerea , Mäkäräinen Elisa , Paarnio Karoliina , Komljen Mirjana , Andos Shadi , Pastor Enrique , Delrio Paolo , Rega Daniela , Biondi Alberto , Lorenzon Laura , Giuliani Giuseppe , Salvischiani Lucia , Borin Simona , Fumagalli Uberto , Fernández Miguel Tamara , Sánchez Santos Raquel , Fernández Martinez Daniel , Gálvez Saldaña Ana , Ricardo Frago Montanuy José , Hurtado Caballero Elena , Dujouné Paula , Ruíz Soriano María , de Andrés Asenjo Beatriz , Taoum Christophe , Krappitz Anna , Westphal Luzie , Sánchez-Guillén Luis , Jacobs-Tulleneers-Thevissen Daniel , Bugra Dursun , Ozoran Emre , Calabrò Marcello , Dohrn Niclas , Die Trill Javier , Jayne David , Gerjy Roger , Ulrich Alexis 
Published: June 2023

Abstract

Background
The impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours.

Methods
This was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy—absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy.

Results
Some 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures.

Conclusion
No difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery.