Surgical approach to right colon cancer: From open technique to robot. State of art

Abstract

This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical, oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary. Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.

Keywords: Mini-invasive right colectomy; Robotic right colectomy; Intracorporeal anastomosis; Extracorporeal anastomosis; Totally laparoscopic right colectomy

Core tip: We report a topic highlight of the mini-invasive treatment of the right colon pathologies, focusing on the Literature State of Art and comparing the open surgery vs the different laparoscopic and robotic procedures. We try to analyze the different current approaches to right colon cancer treatment focusing in particular light and shadows of totally laparoscopic right colectomy compared to other mini-invasive (single incision laparoscopic colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, robotic right colectomy) and open procedure. The two main characteristics of these techniques are the different type of anastomosis: Intracorporeal or extracorporeal and the different incision (suprapubic vs median vs transverse on right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The laparoscopic techniques with intracorporeal anastomosis for the right colon remain a technical challenge but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures described in our study even if further prospective randomized trials are necessary to confirm it.