Robotic complete mesocolic excision with central vascular ligation for right colonic tumours—technical notes and oncological outcomes compared to a propensity score-matched laparoscopic group

Background: Laparoscopic complete mesocolic excision (CME) of the right colon with central vascular ligation (CVL) is a technically-demanding procedure. We retrospectively evaluated the feasibility, safety and oncological outcomes of the procedure when performed using the da Vinci® robotic system.

Materials and Methods: A prospective case series was collected over three years for patients with right colonic cancers treated by standardised robotic CME with CVL using superior mesenteric vein (SMV) first approach. The CME group was compared to a 2:1 propensity score-matched non-CME group who had conventional laparoscopic right colectomy (D2). Primary outcomes were total lymph node harvest and length of specimen. Secondary outcomes were operative time, postoperative complications, and disease-free and overall survival.

Results: The study included 120 patients (40 in the CME group and 80 in the non-CME group). Lymph node yield was higher (29 vs. 18, p=0.006), and specimen length longer (322 vs. 260 mm, p=0.001) and operative time was significantly longer (180 vs. 130 min, p<0.001), with robotic CME versus laparoscopy, respectively. Length of hospital stay was longer with robotic CME (six vs. five days, p=0.088). There were no significant differences in R0 resection rate, complications, readmission rates and local recurrence. There was survival advantage with robotic CME for disease-free (p=0.0454) and overall survival (p=0.0581) at 3 years.

Conclusions: Robotic CME with CVL is feasible and, although currently associated with a longer operation time, and provides good specimen quality, higher lymph node yield and acceptable morbidity. There is a significant survival advantage in the CME group both for disease free and overall survival.