Robotic-assisted colectomy for right-sided colon cancer: Short-term surgical outcomes of a multi-institutional prospective cohort study in Japan

Shinichi Yamauchi; Akio Shiomi; Chu Matsuda; Ichiro Takemasa; Tsunekazu Hanai; Mamoru Uemura; Yusuke Kinugasa

doi:10.1002/ags3.12694

Robotic-assisted colectomy for right-sided colon cancer: Short-term surgical outcomes of a multi-institutional prospective cohort study in Japan

Ann Gastroenterol Surg. 2023 May 23;7(6):932-939. doi: 10.1002/ags3.12694. eCollection 2023 Nov.

Authors

Shinichi Yamauchi¹, Akio Shiomi², Chu Matsuda³, Ichiro Takemasa⁴, Tsunekazu Hanai⁵, Mamoru Uemura⁶, Yusuke Kinugasa¹

Affiliations

¹ Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan.
² Division of Colon and Rectal Surgery Shizuoka Cancer Center Shizuoka Japan.
³ Department of Gastroenterological Surgery Osaka International Cancer Institute Osaka Japan.
⁴ Department of Surgery, Surgical Oncology and Science Sapporo Medical University Hokkaido Japan.
⁵ Department of Gastroenterological Surgery Fujita Health University Aichi Japan.
⁶ Department of Gastroenterological Surgery, Graduate School of Medicine Osaka University Osaka Japan.

Abstract

Background: In Japan, there are no substantial reports on robotic-assisted colectomy because few institutions performed the procedure, as it was not covered by national insurance until March 2022.

Aim: This study aimed to evaluate the safety and feasibility of robotic-assisted colectomy for patients with curatively resectable colon cancer in Japan.

Methods: This multi-institutional, prospective, single-arm, observational study enrolled patients diagnosed with curatively resectable clinical stage I-IIIC colon adenocarcinoma with D2 or D3 lymph node dissection and treated with robotic-assisted colectomy. The primary endpoint was the conversion rate to laparotomy. The non-inferiority of outcomes for robotic-assisted colectomy versus laparoscopic colectomy, which was determined from historical data, was verified.

Results: One hundred patients were registered between July 2019 and March 2022 and underwent robotic-assisted colectomy performed by seven expert surgeons at six institutions. Thirteen patients were excluded because their surgeons had insufficient experience performing robotic-assisted colectomy; therefore, 87 patients were eligible for the primary endpoint analysis. There was no conversion in these 87 patients, and robotic-assisted colectomy was non-inferior to laparoscopic colectomy in terms of conversion rate (90% confidence interval 0-3.38, p = 0.0006). No intraoperative adverse events occurred, and no mortality was observed in a total of 100 patients. The rate of patients with Clavien-Dindo complications grade III or higher was 4%.

Conclusion: This study showed the non-inferiority of the conversion rates between robotic-assisted colectomy and laparoscopic colectomy. Favorable perioperative outcomes also suggest the safety and feasibility of robotic-assisted colectomy.

Keywords: colectomy; colon cancer; laparoscopy; minimally invasive surgical procedures; robotics.