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
Processing time: 143 Days and 16.5 Hours
ARTICLE HIGHLIGHTS
Research background

Several studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Although robotic surgery is related to better recovery outcomes compared to the laparoscopic approach it is associated with higher costs. In the last decades, life expectancy has constantly improved causing a higher incidence of malignancies. At the same time, elderly patients have more comorbidities and are usually more prone to post-operative complications. Consequently, due to progressive aging of the population, an increasing number of minimally invasive procedures are performed on patients over 75 years old with several comorbidities.

Research motivation

Currently, it is difficult to predict which patients could effectively benefit from a robotic approach. In this study we assessed the burden of age and comorbidities on laparoscopic vs robotic surgery for right colon cancer.

Research objectives

The aim of the study was to determine the differences in postoperative outcomes in terms of length of hospitalization and bowel function recovery in patients who underwent laparoscopic or RRH. Moreover, our study also evaluated the impact of elderly age and comorbidities on surgical results.

Research methods

We retrospectively collected and analyzed data on patients who underwent laparoscopic and RRH from January 2014 until September 2019. Adult patients with a diagnosis of adenocarcinoma or endoscopically unresectable adenoma of the right colon were included. The study evaluated the short-term outcomes including the length of hospital stay (LOS), time to first flatus (TFF) and time to first stool evacuation. Epidemiologic characteristics, clinicopathologic features, perioperative variables, and post-operative outcomes were analyzed in the two groups (laparoscopic and robotic). Further analysis of outcomes was performed by comparing patients in terms of age and comorbidities.

Research results

LOS, TFF and time to first stool were significantly shorter in the group of patients who underwent robotic surgery. Following multivariable analysis, the robotic technique was confirmed to be predictive of a significantly shorter hospitalization and faster restoration of bowel function; in addition, age over 75 years and the age-adjusted Charlson Comorbidity Index of more than 7 were significant predictors of hospital stay. Following sub-group analysis, patients aged over 75 years had longer LOS and later TFF, while patients with an age-adjusted Charlson Comorbidity Index of more than 7 were associated with a prolonged LOS.

Research conclusions

In conclusion, RRH is feasible and related to shorter LOS when compared to laparoscopic right hemicolectomy, but old age and several comorbidities tend to reduce its benefits. The robotic approach could be taken into consideration as a surgical option even in older patients with comorbidities, but its high costs should always be taken into account.

Research perspectives

Larger prospective studies and randomized trials are warranted to evaluate and compare laparoscopic and RRH, and to analyze the outcomes and costs. Further research into this field should include more extensive data sets to evaluate the impact of age and comorbidities in robotic surgery of the colon; moreover, these studies should also reveal other variables that may assist in selecting patients that could benefit from this expensive minimally invasive technique.