The exposure was the robotic technique the control was the laparoscopic technique, the current standard treatment for carcinoma or endoscopically unresectable adenoma of the right colon. The secondary outcomes were time to first flatus (TFF) and time to first stool (TFS) evacuation. The primary clinical outcome of the study was the length of hospital stay (LOS) measured in days. The selection bias was minimized by restricting the study to a narrow range of pathologies in a defined population moreover, the surgical indications (related to tumor stage or patients’ comorbidities) and post-operative management were identical in the two groups. The discharge criteria were: Apyrexia, oral intake of solid diet, and normal bowel and urinary function. The post-operative period was managed following enhanced recovery after surgery protocols. No bowel preparation was prescribed, and a short-term prophylactic antibiotic treatment was administered 30 min before surgery. A colonoscopy and a chest-abdomen computed tomography scan were performed as pre-operative investigations as well as an anesthesia evaluation and blood tests. Surgical procedures were performed according to standardized techniques by two operators with consistent experience in minimally invasive surgery (Tagliabue F and Chiarelli M). The Division of General Surgery performs approximately 150 colorectal resections per year and robotic colonic surgery was routinely introduced from 2017. The Alessandro Manzoni Hospital is defined as a tertiary–level Hospital. Patients submitted for multivisceral resection or emergency procedures were excluded. In all cases, diagnosis was confirmed by definitive histopathologic examination. Adult (age > 18 years) patients with a diagnosis of adenocarcinoma or endoscopically unresectable adenoma of the right colon (cecum, ascending colon, and hepatic flexure) were included. We retrospectively collected and analyzed data on patients who underwent minimally invasive laparoscopic or RRH at the Robotic and Emergency Surgery Department of the Alessandro Manzoni Hospital, Lecco, from January 2014 until September 2019. Therefore, we conducted this retrospective study to assess the burden of age and comorbidities on laparoscopic vs robotic surgery for right colon cancer. Even if the laparoscopic approach for right colon resection is considered feasible in elderly patients, most of the studies, analyzing minimally invasive surgery, tend to exclude this population, as they are considered to be more prone to post-operative morbidity, especially when it comes to procedures requiring long anesthesia and preternatural operative positions. At the same time, elderly patients present with more comorbidities which usually lead to a high risk of post-operative complications. In the last decades, life expectancy has constantly improved causing a higher incidence of malignancies.
In addition, international studies have shown the safety, feasibility and oncologic adequacy of robotic right hemicolectomy (RRH). Since its introduction in the early 2000’s, robotic surgery seems to offer a solution to this issue, overcoming the technical limitations associated with the laparoscopic approach, thanks to the multiple degrees of freedom of instrumentation and 3-dimensional imaging. Nevertheless, laparoscopic right hemicolectomy (LRH) can be technically challenging, and its learning curve has been demonstrated to be consistently longer than the open approach. Moreover, better recovery, consisting of less post-operative pain and shorter hospital stay, after laparoscopic right colon resection has now resulted in this minimally invasive procedure being the gold standard for surgical treatment of ascending colon neoplasms.
Several studies have demonstrated that the laparoscopic approach for treatment of right colon cancer is safe and feasible, and its outcomes are equivalent to open surgery. Minimally invasive surgery has gained wide acceptance for colon cancer resection.
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