Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes

International Journal of Colorectal Disease volume 34, pages471–479(2019)Cite this article

Abstract

Background

Recently, an operative strategy involving complete mesocolic excision (CME) and central vascular ligation (CVL) for colonic cancer has been introduced. We aimed to describe our initial experience and assess the long-term outcomes of robotic modified CME (mCME) and CVL (mCME+CVL) for right-sided colon cancer.

Methods

Of the 677 patients with histologically confirmed, right-sided colon adenocarcinoma who underwent curative mCME+CVL between February 2008 and October 2016, 43 who were treated entirely using the robotic approach were included in this retrospective study. Survival rates were determined using the Kaplan-Meier method, and P values of < 0.05 indicated statistically significant differences.

Results

The total operation and docking times were 293 (180–644) min and 5 (3–19) min, respectively, with an estimated blood loss of 50 (10–400) mL. The time to soft diet was 4 (1–16) days and the length of hospitalization was 8 (4–48) days. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IV complications were noted in 3 (7.0%), 5 (11.7%), 2 (4.7%), 1 (2.3%), and 0 (0%) patients, respectively. The proximal and distal resection margins were 14 (4–54) and 19 (4–48) cm, respectively, and 29 (6–157) lymph nodes were harvested per patient. The patients were followed-up for a median of 55 (2–109) months, during which the overall survival rate, median disease-free period, disease-free survival rate, and tumor recurrence rate were 93.6%, 38 (2–109) months, 81.1%, and 16.3% (7 patients), respectively.

Conclusions

Robotic mCME and CVL for right-sided colon cancer was feasible and safe. It can be added to the surgeon’s toolbox as an optional strategy for the management of colon cancer patients.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Wibe A, Moller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, Langmark F, Myrvold HE, Soreide O (2002) A national strategic change in treatment policy for rectal cancer–implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 45(7):857–866

    Article  PubMed  Google Scholar 

  2. 2.

    Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gögenur I, Danish Colorectal Cancer Group (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16(2):161–168

    Article  PubMed  Google Scholar 

  3. 3.

    Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis 11(4):354–364 discussion 364–355

    Article  CAS  Google Scholar 

  4. 4.

    Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N (2014) Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261:708–715. https://doi.org/10.1097/SLA.0000000000000831

    Article  Google Scholar 

  5. 5.

    Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, Park YA, Chun HK (2017) Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 32:2721–2731. https://doi.org/10.1007/s00464-017-5970-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Bae SU, Kim CN (2015) Laparoscopic complete mesocolic excision and central vascular ligation for right-sided colon cancer using the retroperitoneal approach. Dis Colon Rectum 58(8):816

    Article  PubMed  Google Scholar 

  7. 7.

    Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Tyler JA, Fox JP, Desai MM, Perry WB, Glasgow SC (2013) Outcomes and costs associated with robotic colectomy in the minimally invasive era. Dis Colon Rectum 56(4):458–466

    Article  PubMed  Google Scholar 

  9. 9.

    Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19(2):140–146

    Article  PubMed  Google Scholar 

  10. 10.

    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  Google Scholar 

  11. 11.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Kariv Y, Delaney CP (2005) Robotics in colorectal surgery. Minerva Chir 60(5):401–416

    CAS  PubMed  Google Scholar 

  13. 13.

    Rawlings AL, Woodland JH, Crawford DL (2006) Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases. Surg Endosc 20(11):1713–1718

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138(7):777–784

    Article  PubMed  Google Scholar 

  15. 15.

    Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N (2015) Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261(4):708–715

    Article  PubMed  Google Scholar 

  16. 16.

    Bertelsen CA, Neuenschwander AU, Jansen JE, Kirkegaard-Klitbo A, Tenma JR, Wilhelmsen M, Rasmussen LA, Jepsen LV, Kristensen B, Gögenur I, the Copenhagen Complete Mesocolic Excision Study (COMES), the Danish Colorectal Cancer Group (DCCG) (2016) Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg 103(5):581–589

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y (2017) Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Color Dis 19(11):962–972

    Article  CAS  Google Scholar 

  18. 18.

    Spinoglio G, Bianchi PP, Marano A, Priora F, Lenti LM, Ravazzoni F, Petz W, Borin S, Ribero D, Formisano G, Bertani E (2018) Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 patients. Ann Surg Oncol 25:3580–3586. https://doi.org/10.1245/s10434-018-6752-7

    Article  PubMed  Google Scholar 

  19. 19.

    Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2014) Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol 21(7):2288–2294

    Article  PubMed  Google Scholar 

  20. 20.

    van Oostendorp S, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, Tuynman J (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31(1):64–77

    Article  PubMed  Google Scholar 

  21. 21.

    Yeo SA, Noh GT, Han JH, Cheong C, Stein H, Kerdok A, Min BS (2017) Universal suprapubic approach for complete mesocolic excision and central vascular ligation using the da Vinci Xi(R) system: from cadaveric models to clinical cases. J Robot Surg 11:399–407. https://doi.org/10.1007/s11701-016-0664-y

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2017R1C1B5076880).

This work was also supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).

Author information

Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, South Korea

    Sung Uk Bae

  2. Department of Surgery, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, South Korea

    Sung Uk Bae, Seung Yoon Yang & Byung Soh Min

Authors
  1. Sung Uk Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seung Yoon Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Byung Soh Min
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Byung Soh Min.

Ethics declarations

Conflicts of interest

Drs. Bae, Yang, and Min have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

(WMV 216772 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bae, S.U., Yang, S.Y. & Min, B.S. Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes. Int J Colorectal Dis 34, 471–479 (2019). https://doi.org/10.1007/s00384-018-3208-2

Download citation

Keywords

  • Complete mesocolic excision
  • Robotic modified CME
  • Colon cancer