Published online Jun 27, 2020. doi: 10.4240/wjgs.v12.i6.287
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
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.
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.
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.
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.
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.
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.
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.