Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2020; 12(6): 287-297
Published online Jun 27, 2020. doi: 10.4240/wjgs.v12.i6.287
Robotic vs laparoscopic right colectomy – the burden of age and comorbidity in perioperative outcomes: An observational study
Fulvio Tagliabue, Morena Burati, Marco Chiarelli, Luca Fumagalli, Angelo Guttadauro, Elisa Arborio, Matilde De Simone, Ugo Cioffi
Fulvio Tagliabue, Morena Burati, Marco Chiarelli, Luca Fumagalli, Elisa Arborio, Department of Robotic and Emergency Surgery, Ospedale A. Manzoni, ASST Lecco, Lecco 23900, Italy
Angelo Guttadauro, Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Monza 20900, Italy
Matilde De Simone, Ugo Cioffi, Department of Surgery, University of Milan, Milano 20122, Italy
Author contributions: Tagliabue F designed the overall concept of the study; Tagliabue F, Chiarelli M and Fumagalli L revised the manuscript; Burati M, Guttadauro A and Arborio E contributed to data acquisition; Burati M drafted the manuscript; Chiarelli M designed the study; Fumagalli L and Chiarelli M analyzed the data; Guttadauro A reviewed the manuscript; Arborio E reviewed the literature; De Simone M contributed to the interpretation of the data and revised the discussion; Cioffi U contributed to the design the study, interpreted the results and reviewed the discussion and conclusions; all Authors approved the final version of the manuscript to be published.
Institutional review board statement: This study was reviewed and approved by the Ethical Committee of Lecco Hospital (protocol number ID RP02-0008564/17U).
Informed consent statement: The patients of this study signed an inform consent.
Conflict-of-interest statement: All Authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ugo Cioffi, MD, PhD, Full Professor, Surgeon, Department of Surgery, University of Milan, Via F Sforza 35, Milano 20122, Italy. ugocioffi5@gmail.com
Received: January 27, 2020
Peer-review started: January 27, 2020
First decision: April 3, 2020
Revised: May 13, 2020
Accepted: May 16, 2020
Article in press: May 16, 2020
Published online: June 27, 2020
Abstract
BACKGROUND

Several studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Laparoscopic right hemicolectomy (LRH) is considered technically challenging. Robotic surgery has been introduced to overcome this technical limitation, but it is related to high costs. To maximize the benefits of such surgery, only selected patients are candidates for this technique. In addition, due to progressive aging of the population, an increasing number of minimally invasive procedures are performed on elderly patients with severe comorbidities, who are usually more prone to post-operative complications.

AIM

To investigate the outcomes of RRH vs LRH with regard to age and comorbidities.

METHODS

We retrospectively analyzed 123 minimally invasive procedures (68 LRHs vs 55 RRHs) for right colon cancer or endoscopically unresectable adenoma performed in our Center from January 2014 until September 2019. The surgical procedures were performed according to standardized techniques. The primary clinical outcome of the study was the length of hospital stay (LOS) measured in days. Secondary outcomes were time to first flatus (TFF) and time to first stool evacuation. The robotic technique was considered the exposure and the laparoscopic technique was considered the control. Routine demographic variables were obtained, including age at time of surgery and gender. Body mass index and American Society of Anesthesiologists physical status were registered. The age-adjusted Charlson Comorbidity Index (ACCI) was calculated; the tumor-node-metastasis system, intra-operative variables and post-operative complications were recorded. Post-operative follow-up was 180 d.

RESULTS

LOS, TFF, and time to first stool were significantly shorter in the robotic group: Median 6 [interquartile range (IQR) 5-8] vs 7 (IQR 6-10.5) d, P = 0.028; median 2 (IQR 1-3) vs 3 (IQR 2-4) d, P < 0.001; median 4 (IQR 3-5) vs 5 (IQR 4-6.5) d, P = 0.005, respectively. Following multivariable analysis, the robotic technique was confirmed to be predictive of significantly shorter hospitalization and faster restoration of bowel function; in addition the dichotomous variables of age over 75 years and ACCI more than 7 were significant predictors of hospital stay. No outcomes were significantly associated with Clavien-Dindo grading. Sub-group analysis demonstrated that patients aged over 75 years had a longer LOS (median 6 -IQR 5-8- vs 7 -IQR 6-12- d, P = 0.013) and later TFF (median 2 -IQR 1-3- vs 3 -IQR 2-4- d, P = 0.008), while patients with ACCI more than 7 were only associated with a prolonged hospital stay (median 7 -IQR 5-8- vs 7 -IQR 6-14.5- d, P = 0.036).

CONCLUSION

RRH is related to shorter LOS when compared with the laparoscopic approach, but older age and several comorbidities tend to reduce its benefits.

Keywords: Right hemicolectomy, Robotic surgery, Laparoscopic surgery, Elderly patients, Comorbidity, Hospital stay

Core tip: Older age and severe comorbidities affect recovery after minimally invasive surgery for right colon cancer. Robotic right hemicolectomy is related to better recovery outcomes compared to the laparoscopic approach but is associated with higher costs. Therefore, the robotic approach in older patients with severe comorbidities should be evaluated in terms of higher cost.