KOLON KANSERİNDE ROBOTİK VE AÇIK SAĞ KOLEKTOMİNİN POSTOPERATİF VE ONKOLOJİK SONUÇLARININ KARŞILAŞTIRILMASI

Abstract

Amaç: Bu çalışma, sağ kolon kanseri için robotik sağ hemikolektominin kısa vadeli sonuçlarını konvansiyonel sağ hemikolektomiyle karşılaştırmayı amaçlamaktadır. Gereç ve Yöntem: 2020-2022 yılları arasında sağ taraf yerleşimli kolorektal kanser nedeniyle cerrahi tedavi uygulanan hastalar çalışmaya dahil edildi. Hastalar konvansiyonel cerrahi geçirenler Grup 1, robotik cerrahi uygulananlar Grup 2 olmak üzere 2 gruba ayrıldı. Bu gruplarda hastalara ait klinik veriler ve peroperatif sonuçlar karşılaştırıldı. Bulgular: Çalışmamıza 51 hasta katıldı. Grup 1 39 hastadan, Grup 2 12 hastadan oluşuyordu. Yaş ortalaması (60,7 ve 62,3 p=0,773) idi. Hiçbir dönüşüm veya intraoperatif komplikasyon oluşmadı. Genişletilmiş sağ hemikolektomi (%23,1 ve %8,36 p=0,083) oranında uygulandı. Operasyon süresi Grup 2'de uzundu (2,84 ve 3,04 p=0,023). Grup 1’de bir hasta postoperatif dönemde ileus nedeniyle tekrar ameliyat edildi. En sık T3 evre tümörler (%48,7 ve %50, p=0,794) ve N0 (%38,5 ve %41,7, p=0,827) saptanmıştı. Lenf nodu diseksiyonu sayıları total lenf nodları 37,2 ve 41,9 (p=0,179) ve malign nodlar 2,54 ve 6,42 (p=0,881) idi. En sık görülen Clavien-Dindo skoru her iki grupta da 1 idi (%79,5 ve %83,3, p=0,339). Yatış süresi gruplarda benzerdi (6,38 ve 5,92, p=0,156). Grup 1'de 6 hastada hastaneye tekrar başvuru görüldü. Başvuru sebepleri anastomoz kaçağı, ileus ve genel durum bozukluğu idi. Sonuç: Deneyimlerimiz sağ kolon kanserinin tedavisi için robotik cerrahinin fizibilitesini ve güvenliğini doğrulamaktadır. Bu yöntem tatmin edici kısa vadeli sonuçlar sağlamıştır.

Keywords

• Kolorektal kanser
• robotik cerrahi
• sağ kolektomi
• postoperatif komplikasyon
• onkolojik sonuçlar

COMPARISON OF POSTOPERATIVE AND ONCOLOGICAL OUTCOMES IN ROBOTIC AND OPEN RIGHT COLECTOMY FOR COLON CANCER

Abstract

Objective:This study aims to compare the short-term outcomes of robotic right hemicolectomy for right sided colon cancer to those of conventional open right hemicolectomy. Material and Method:Patients who underwent surgical treatment for right sided colorectal cancer between 2020 and 2022 were included in the study. Patients had been divided into 2 groups: Group1, who underwent conventional surgery, and Group2, who underwent robotic surgery.Clinical data and peropative findings of patients were compared between the groups. Result:A total of 51 patients participated in our study. Group1 consisted of 39 patients and Group2 consisted of 12 patients. The mean age was 60.7 vs. 62.3 (p=0.773). No conversions or intraoperative complications occurred. Extended right hemicolectomy was performed in 23.1% vs. 8.36% (p=0.083). The operation time was longer in Group2 (2.84 vs. 3.04,p=0.023). One patient in Group 1 underwent reoperation for ileus during the postoperative period. T3 stage tumors (48.7% vs. 50%,p=0.794) and N0 lymph node metastasis (38.5% vs. 41.7%,p=0.827) were detected most frequently. The total number of lymph nodes dissected was 37.2 vs. 41.9 (p=0.179). The number of malignant lymph nodes was 2.54 vs. 6.42 (p=0.881). The most common Clavien-Dindo score was 1 in both groups (79.5% vs. 83.3%,p=0.339). The length of stay was similar between the groups (6.38 vs. 5.92, p=0.156). Readmission occurred in 6 patients in Group1, with reasons being anastomotic leakage, ileus, and general condition disorder. Conclusion:Our experience shows the feasibility and safety of robotic surgery for the treatment of right sided colonic cancer. This method has provided satisfactory short-term outcomes.

Keywords

• Colorectal cancer
• Robotic surgery
• Right colectomy
• Postoperative complications
• Oncologic outcomes

References

1. Zelhart M, Kaiser AM. Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 2018;32(1):24-38. [CrossRef] google scholar
2. Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Transl Oncol 2021;14(10):101174. [CrossRef] google scholar
3. Rausa E, Kelly ME, Asti E, Aiolfi A, Bonitta G, Bonavina L. Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach. Surg Endosc 2019;33(4):1020-32. [CrossRef] google scholar
4. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 2013;100(1):75-82. [CrossRef] google scholar
5. Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009;10(1):44-52. [CrossRef] google scholar
6. Spinoglio G, Marano A, Bianchi PP, Priora F, Lenti LM, Ravazzoni F, et al. Robotic Right Colectomy with Modified Complete Mesocolic Excision: Long-Term Oncologic Outcomes. Ann Surg Oncol 2016;23(Suppl 5):684-91. [CrossRef] google scholar
7. Hannan E, Feeney G, Ullah MF, Ryan C, McNamara E, Waldron D, et al. Robotic versus laparoscopic right hemicolectomy: a case-matched study. J Robot Surg 2022;16(3):641-7. [CrossRef] google scholar
8. Tan A, Ashrafian H, Scott AJ, Mason SE, Harling L, Athanasiou T, et al. Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and metaanalysis of the first 30 years. Surg Endosc 2016;30(10):4330- 52. [CrossRef] google scholar

9. Weiser MR. AJCC 8th Edition: Colorectal Cancer. Ann Surg Oncol 2018;25(6):1454-5. [CrossRef] google scholar
10. American College of Surgeons. User guide for the 2012 ACS NSQIP participant use data file (PUF). Chicago: 014 Jan. Available from: URL: https://www.facs.org/media/ r23m4qap/acsnsqip2012ptpuf-userguide. google scholar
11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205-13. [CrossRef] google scholar
12. Bertelsen CA, Neuenschwander AU, Jansen JE, Kirkegaard- Klitbo A, Tenma JR, Wilhelmsen M, et al. Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg 2016;103(5):581-9. [CrossRef] google scholar
13. Gavriilidis P, Davies RJ, Biondi A, Wheeler J, Testini M, Carcano G, et al. Laparoscopic versus open complete mesocolic excision: a systematic review by updated metaanalysis. Updates Surg 2020;72(3):639-48. [CrossRef] google scholar
14. Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2017;9(12):475-91. [CrossRef] google scholar
15. Larach JT, Flynn J, Wright T, Rajkomar AKS, McCormick JJ, Kong J, et al. Robotic complete mesocolic excision versus conventional robotic right colectomy for rightsided colon cancer: a comparative study of perioperative outcomes. Surg Endosc 2022;36(3):2113-20. [CrossRef] google scholar
16. Hirschburger M, Schneider R, Kraenzlein S, Padberg W, Hecker A, Reichert M. Right colectomy from open to robotic - a single-center experience with functional outcomes in a learning-curve setting. Langenbecks Arch Surg 2022;407(7):2915-27. [CrossRef] google scholar
17. Quirke P, West N. Quality of surgery: has the time come for colon cancer? Lancet Oncol 2015;16(2):121-2. [CrossRef] google scholar
18. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010;28(2):272-8. [CrossRef] google scholar
19. Kelley SR, Duchalais E, Larson DW. Robotic right colectomy with intracorporeal anastomosis for malignancy. J Robot Surg 2018;12(3):461-6. [CrossRef] google scholar
20. Keller DS, Senagore AJ, Lawrence JK, Champagne BJ, Delaney CP. Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 2014;28(1):212-21. [CrossRef] google scholar
21. Huscher CGS, Lazzarin G, Marchegiani F, Marks J. Robotic right colectomy with robotic-sewn anastomosis: a pilot case series. J Robot Surg 2023;17(2):427-34. [CrossRef] google scholar