Robotic right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy: Perioperative complications and oncologic outcomes

Abstract

Background

Hemicolectomy with complete mesocolic excision and D3 lymphadenectomy is associated with high lymph node yield and favorable oncologic outcomes; however, there are concerns over the safety of the procedure given the extent of dissection required.

Methods

We retrospectively analyzed the rates of complications and disease-free survival in patients with cancer in the ascending colon, terminal ileum, or appendix who underwent a robotic right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy at our comprehensive cancer center between 2014 and 2024.

Results

For the 631 patients included in the analysis, median operative time was 165 (IQR 140–188) min, with median blood loss of 25 (IQR 25–50) ml. Complications of Clavien-Dindo grade ≥III occurred in 15 patients (2.4 %), including 7 patients (1.1 %) with anastomotic leak. Median hospital stay was 4 (IQR 3–5) days, with 38 patients (6.0 %) readmitted and 2 deaths (0.3 %) within 30 days. For 536 patients with colon adenocarcinoma, the median number of lymph nodes harvested was 30.5 (IQR 23–42); with median follow-up of 42.8 months, 2 patients had a local (anastomotic) recurrence and 61 had a distant recurrence. Disease-free survival at 5 years in patients treated for stage I, II, or III colon cancer was 98.5 %, 89.9 %, and 68.6 %, respectively.

Conclusions

Robotic right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy can be performed with low morbidity by experienced surgeons. Outcomes compare favorably to the outcomes of standard colectomy and are similar to the outcomes of open and laparoscopic D3 colectomies.