Petz W, Ribero D, Bertani E, Borin S, Formisano G, Esposito S, Spinoglio G, Bianchi P P
Department of Hepatobiliary, Pancreatic and Digestive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
Department of General and Minimally-Invasive Surgery, Misericordia Hospital, Via Senese 159, 58100 Grosseto, Italy.
Eur J Surg Oncol. 2017 Nov;43(11):2060-2066. doi: 10.1016/j.ejso.2017.07.020. Epub 2017 Aug 10.
Right-sided colon cancer has a worse prognosis than left-sided colon cancer. Complete mesocolic excision (CME) with central vessels ligation (CVL) reduces local recurrence, but is technically demanding, particularly with a laparoscopic approach. Aim of this study is to describe a new robotic approach to right colectomy with CME and CVL and to report oncologic safety and short term outcomes.
Twenty consecutive patients were included. All patients had a right colon adenocarcinoma and underwent right colectomy with a suprapubic approach. Surgery was realized with the Da Vinci Xi system and all trocars were placed along a horizontal line 3-6 cm above the pubis. CME with CVL was realized in all the patients. Data analysed were: duration of surgery, conversions to open surgery, intraoperative and postoperative complication by Clavien Dindo classification, margins of resections, length of specimen and number of lymph nodes retrieved.
Patients median age was 69 years, median body mass index was 27 kg/m. Median operative time was 249 min, blood loss was negligible, no conversions to open or laparoscopic surgery occurred. Median hospital stay was six days; two postoperative grade IIIa Clavien-Dindo complications occurred, no 30-days postoperative death was registered. Resection margins were negative in all patients; median tumour diameter was 3.6 cm, median specimen length was 40 cm, median number of harvested lymph nodes was 40.
Robotic right colectomy with CME using a suprapubic approach is a feasible and safe technique that allows for an extended lymphadenectomy and provides high quality surgical specimens.
右半结肠癌的预后比左半结肠癌差。完整结肠系膜切除术（CME）联合中央血管结扎术（CVL）可降低局部复发率，但技术要求较高，尤其是采用腹腔镜手术时。本研究的目的是描述一种新的机器人辅助右半结肠切除术联合CME和CVL的方法，并报告其肿瘤学安全性和短期结果。
连续纳入20例患者。所有患者均患有右半结肠腺癌，并采用耻骨上入路行右半结肠切除术。手术使用达芬奇Xi系统进行，所有套管针均沿耻骨上方3-6厘米的水平线放置。所有患者均实施了CME联合CVL。分析的数据包括：手术时间、转为开放手术的情况、根据Clavien Dindo分类的术中及术后并发症、切除切缘、标本长度和获取的淋巴结数量。
患者中位年龄为69岁，中位体重指数为27kg/m。中位手术时间为249分钟，出血量可忽略不计，未发生转为开放手术或腹腔镜手术的情况。中位住院时间为6天；发生了2例术后Clavien-Dindo IIIa级并发症，无30天术后死亡病例。所有患者的切除切缘均为阴性；中位肿瘤直径为3.6厘米，中位标本长度为40厘米，中位获取淋巴结数量为40个。
采用耻骨上入路的机器人辅助右半结肠切除术联合CME是一种可行且安全的技术，可实现扩大淋巴结清扫，并提供高质量的手术标本。
