Department of Surgery, San Paolo Hospital, University of Milano, Via A. di Rudinì 8, 20142, Milan, Italy.
Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy.
Updates Surg. 2021 Jun;73(3):1065-1072. doi: 10.1007/s13304-021-01001-x. Epub 2021 Mar 5.
Technical and oncological aspects are still debated when dealing with minimally-invasive right colectomy. Main controversial issues still remain about whether the anastomosis should be performed intra- or extracorporeally and if a complete mesocolic excision (CME) should be carried out. We report the feasibility of robotic right colectomy with CME and intracorporeal anastomosis (IA) for right sided colon cancer. Data from patients who underwent robotic right colectomy with IA and CME from January 2015 to April 2020 were prospectively collected and retrospectively analyzed. Intraoperative outcomes and complications (minor I-II and major III-IV according to Clavien-Dindo classification), conversion rate, 30-day postoperative outcomes and pathological outcomes were the variables assessed. A total of 161 patients undergoing robotic right colectomy for cancer met the inclusion criteria. Mean operative time was 185 min, no intraoperative complications were observed, and the conversion rate was 3.7% (6 patients requiring elective conversions). Overall, mean postoperative stay was 4.9 days and the overall 30-day complication rate was 16.1%. 20 patients (12.4%) had minor complications, while major postoperative complications occurred in six patients (3.7%). Anastomotic leak was recorded in one patient (0.6%) and the 30-day re-admission rate was 0.6%. Mean number of harvested lymph nodes was 21.9. Patients requiring conversion experienced two minor complications, with a mean length of stay of 7 days. Robotic right colectomy with CME and IA is feasible and it is associated with good intraoperative and short-term postoperative clinical outcomes.
在进行微创右结肠切除术时,技术和肿瘤学方面仍存在争议。主要的争议问题仍然是吻合应该在体内还是体外进行,以及是否应进行完整结肠系膜切除术(CME)。我们报告了机器人辅助右结肠切除术伴 CME 和体内吻合(IA)治疗右侧结肠癌的可行性。从 2015 年 1 月至 2020 年 4 月,前瞻性收集并回顾性分析了接受机器人辅助右结肠切除术伴 IA 和 CME 的患者数据。评估的变量包括术中结果和并发症(根据 Clavien-Dindo 分类为 minor I-II 和 major III-IV)、转化率、30 天术后结果和病理结果。共有 161 例接受机器人辅助右结肠癌切除术的癌症患者符合纳入标准。平均手术时间为 185 分钟,术中无并发症,转化率为 3.7%(6 例需要择期转换)。总体而言,平均术后住院时间为 4.9 天,30 天总并发症发生率为 16.1%。20 例(12.4%)患者发生轻微并发症,6 例(3.7%)患者发生严重术后并发症。1 例(0.6%)患者发生吻合口漏,30 天再入院率为 0.6%。平均采集的淋巴结数为 21.9 个。需要转换的患者发生了两例轻微并发症,平均住院时间为 7 天。机器人辅助 CME 和 IA 右结肠切除术是可行的,并且具有良好的术中及短期术后临床结果。