Abstract
Introduction:
Complete mesocolic excision (CME) may have a greater lymph node yield than traditional surgery and is associated with better overall and disease-free survival. 1 –3 Owing to technical difficulties in reproducing CME, the robotic approach may provide a safe approach for CME. 4 –6 This video presents a robotic right colectomy with CME for locally advanced cancer of the cecum with pericolic abscess.
Materials and Methods:
An 80-year-old patient presented to the outpatient clinic complaining with diarrhea and a positive fecal occult blood test. Diagnostic work-up included a colonoscopy that showed an adenocarcinoma of the cecum. A preoperative CT scan revealed no distant disease but an abscess of the cecum involving the ileum. Multidisciplinary tumor board indicated surgery and the patient underwent a robotic right colectomy with CME. Robotic CME with central vascular ligation was performed with lymphadenectomy of the main vessels.
Results:
Operative time was 205 minutes. Histologic examination showed a mucinous adenocarcinoma of the cecum with 11 positive lymph nodes out of 22 harvested (pT3 pN2b). No drain was positioned. The patient was discharged on postoperative day 6 and the postoperative course was uneventful. From 2018 to 2023, robotic CME was performed on 110 patients with a median operative time of 184 minutes, blood loss was negligible, no intraoperative complications occurred, mean number of harvested lymph nodes was 25.6 ± 5.9. Three conversions (2.7%) were experienced because of bulky lymph nodes and severe local advanced tumor. Mean postoperative stay was 6 days. Six postoperative complications occurred including four postoperative ileus, one late dehiscence of the colonic stump, and an iatrogenic colonic perforation. The last two patients needed reintervention. At 1-year follow-up, cancer-related overall survival was 95% with stage III disease survival of 80% at 60 months.
Conclusions:
Even though challenging, robotic CME is feasible, effective, and safe and seems to improve lymphadenectomy in locally advanced colon cancer. This technique may be associated with better overall survival.
Patient Consent Statement:
Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
We have no conflicts of interest to disclose.
Runtime of video: 9 mins 54 secs
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