Segmental transverse colectomy. Minimally invasive versus open approach: results from a multicenter collaborative study
Marco Milone, Maurizio Degiuli, Nunzio Velotti, Michele Manigrasso, Sara Vertaldi, Domenico D’Ugo, Giovanni Domenico De Palma, and Italian Society of Surgical Oncology Colorectal Cancer Network (SICO CCN) group, Marco E. Allaix, Carlo Alberto Ammirati, Gabriele Anania, Andrea Barberis, Andrea Belli, Francesco Bianco, Paolo Pietro Bianchi, Cristina Bombardini, Dario Bruzzese, Davide Cavaliere, Claudio Coco, Andrea Coratti, Giovanni De Manzoni, Paola De Nardi, Giuseppe De Simone, Raffaele De Luca, Paolo Delrio, Antonio Di Cataldo, Katia Di Lauro, Alberto Di Leo, Annibale Donini, Ugo Elmore, Andrea Fontana, Giampaolo Formisano, Sergio Gentilli, Giuseppe Giuliani, Luigina Graziosi, Mario Guerrieri, Giovanni Li Destri, Roberta Longhin, Michela Mineccia, Manuela Monni, Mario Morino, Monica Ortenzi, Ugo Pace, Francesca Pecchini, Corrado Pedrazzani, Micaela Piccoli, Sara Pollesel, Salvatore Pucciarelli, Rossella Reddavid, Daniela Rega, Marco Rigamonti, Gianluca Rizzo, Riccardo Rosati, Franco Roviello, Mauro Santarelli, Federica Saraceno, Stefano Scabini, Giuseppe Servillo, Giuseppe Sica, Pierpaolo Sileri, M. De Simone, Luigi Siragusa, Silvia Sofia, Leonardo Solaini, Angela Tribuzi, Giulia Turri, Andrea Vignali, M. Zuin, Michele Zuolo
Abstract
The role of minimally invasive surgery in the treatment of transverse colon cancer is still controversial. The aim of this study is to investigate the advantages of a totally laparoscopic technique comparing open versus laparoscopic/robotic approach. Three hundred and eighty-eight patients with transverse colon cancer, treated with a segmental colon resection, were retrospectively analyzed. Demographic data, tumor stage, operative time, intraoperative complications, number of harvested lymph nodes and recovery outcomes were recorded. Recurrences and death were also evaluated during the follow-up. No differences were found between conventional and minimally invasive surgery, both for oncological long-term outcomes (recurrence rate p = 0.28; mortality p = 0.62) and postoperative complications (overall rate p = 0.43; anemia p = 0.78; nausea p = 0.68; infections p = 0.91; bleeding p = 0.62; anastomotic leak p = 0.55; ileus p = 0.75). Nevertheless, recovery outcomes showed statistically significant differences in favor of minimally invasive surgery in terms of time to first flatus (p = 0.001), tolerance to solid diet (p = 0.017), time to first mobilization (p = 0.001) and hospital stay (p = 0.004). Compared with laparoscopic approach, robotic surgery showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.005) and tolerance to solid diet (p = 0.001). Finally, anastomosis evaluation confirmed the superiority of intracorporeal approach which showed significantly better results for time to first flatus (p = 0.001), to first mobilization (p = 0.003) and tolerance to solid diet (p = 0.001); moreover, we recorded a statistical difference in favor of intracorporeal approach for infection rate (p = 0.04), bleeding (p = 0.001) and anastomotic leak (p = 0.03). Minimally invasive approach is safe and effective as the conventional open surgery, with comparable oncological results but not negligible advantages in terms of recovery outcomes. Moreover, we demonstrated that robotic approach may be considered a valid option and an intracorporeal anastomosis should always be preferred.