Robotic Versus Laparoscopic Right Hemicolectomy With Complete Mesocolic Excision

Study Overview
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Brief Summary
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the investigators performed a retrospective multicenter propensity score matching study. From July 2016 to July 2021, 382 consecutive patients from different Chinese surgical departments were available for inclusion out of an initial cohort of 412, who underwent robotic or laparoscopic right hemicolectomy with CME.

Detailed Description
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All consecutive patients who underwent robotic or laparoscopic right hemicolectomy with CME from July 2016 to July 2021 at three Chinese surgical departments (Department of General Surgery, Army Medical Center, Chongqing;Department of Colorectum, Chongqing University Three Gorges Hospital, Chongqing;Department of Colorectum, the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou) were included in the study. A retrospective review of multicenter institutional database was conducted. The Da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has been employed since 2016 in three centers. From July 2016 to July 2021, an initial cohort of 412 consecutive patients underwent robotic or laparoscopic right hemicolectomy with CME in three departments. With 30 cases meeting the exclusion criteria, 382 cases, including 204 males and 178 females, were available for inclusion. Of these, 149 cases by robotic right hemicolectomy with CME were classified as the robotic group, while the other 233 cases by laparoscopic right hemicolectomy with CME as the laparoscopic group.

Official Title
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Robotic Versus Laparoscopic Right Hemicolectomy With Complete Mesocolic Excision: a Retrospective Multicenter Study With Propensity Score Matching

Conditions
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Perioperative Outcomes, Oncological Outcomes

Intervention / Treatment
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* Procedure: robotic right hemicolectomy with CME


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adenocarcinoma was confirmed by preoperative colonoscopy and it was located in the right colon. Preoperative enhanced abdominal CT examination showed no invasion of abdominal wall or adjacent organs. The patient underwent robotic or laparoscopic right hemicolectomy with CME. Exclusion Criteria: Multiple primary colorectal tumors Metastasis to abdominal Pelvic or distant organs Accompanied with bowel obstruction or perforation Neuroendocrine tumors Lymphomas Other malignant tumors.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| robotic right hemicolectomy with CME<br>The robot was set to come and dock from the right shoulder of the patient. Three robotic 8-mm trocars (R1, R2 and R3) and two 12-mm trocars (camera and assistant port) were used for the robotic procedure. One working arm carrying a monopolar cautery hook/scissors for dissection was located in the left upper quadrant port (R1). The other two working arms carried bipolar forceps in the suprapubic port (R2), and Cadiere's fenestrated forceps in the right lower quadrant port (R3) that was used to keep the superior mesenteric axis in traction. After gentle cephalad traction on the transverse mesocolon with the grasp in R3, the assistant grasped the ileocecal valve through the assistant port to put the ileocolic vascular pedicle on tension and the ileocolic vessels were identified and lifted up with R2. All procedures were performed keeping the principle of complete mesocolic excision. | Procedure: robotic right hemicolectomy with CME<br>* The distribution of trocars was placed according to the position of Intuitive Surgical Inc. for robotic colectomy. The robot was set to come and dock from theright shoulder of the patient. Three robotic 8-mm trocars (R1, R2 and R3) and two 12-mm trocars (camera and assistant port) were used for the robotic procedure. One working arm carrying a monopolar cautery hook for dissection was located in the left upper quadrant port (R1). The other two working arms carried bipolar forceps in the suprapubic port (R3), and Cadiere's fenestrated forceps in the right lower quadrant port (R2) that was used to keep the superior mesenteric axis in traction. After gentle cephalad traction on the transversemesocolon with the grasp in R2, the assistant grasped the ileocecal valve through the assistant port to put the ileocolic vascular pedicle on tension and the ileocolic vessels were identified and lifted up with R3.<br>|
| laparoscopic right hemicolectomy with CME<br>In the aparoscopic group, five trocars were used: a periumbilical incision and left upper quadrant for 12-mm trocars, both lower quadrants for 5-mm trocars, and the right quadrant for one more 5-mm trocar. A 30 degrees laparoscope was inserted through the periumbilical trocar site. After insertion of the trocars, the patient was placed in the Trendelenburg position with a 15 degrees rightward tilt. An ultrasonic device was used for dissection. All procedures were performed keeping the principle of complete mesocolic excision. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| diseasefree survival(months) | Collect outcomes of follow-up and use Kaplan-Meier survival analysis to analyze it. | until July 2021 | 
| overall survival(months) | Collect outcomes of follow-up and use Kaplan-Meier survival analysis to analyze it. | until July 2021 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| conversion rates | the incidence of a conversion to open surgery | during the surgery | 
| operative time | the miniutes of surgery from skin to skin | during the surgery | 
| estimated blood loss | the mililiter of the blood loss during surgery | during the surgery | 
| oral retake | the patients begin to recover intake | up to 30 days after surgery | 
| time to return to bowel function | the patients begin to recover bowel function | up to 30 days after surgery | 
| length of stay | the days of hospital stay | up to 30 days after surgery | 
| total hospitalization cost | the total cost of this treatment by RMB | up to 30 days after surgery | 
| complications | Postoperative complications, such as ileus, anastomotic leak, small intestinal obstruction, bleeding and so on. Number of Participants with complications will be recorded. | up to 30 days after surgery | 
| harvest lymph nodes | the number of harvest lymph nodes in postoperative pathological report | up to 7 days after surgery | 
| lymph node metastasis | the number of patients with lymph node metastasis | up to 7 days after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Robot, Right hemicolectomy, Complete mesocolic excision