Summary of ‘Comparison of short-term outcomes of robotic versus laparoscopic right colectomy for patients ≥ 65 years of age: a systematic review and meta-analysis of prospective studies’
Colorectal cancer (CRC) is a significant health concern, being the third most commonly diagnosed cancer globally and the second leading cause of cancer-related mortality. Notably, 56% of CRC cases occur in individuals aged 65 years and older. Among these, right-sided colon cancers are particularly prevalent, making effective surgical treatment crucial. Both laparoscopic right colectomy (LRC) and robotic right colectomy (RRC) have been employed in surgical management, with previous studies suggesting that laparoscopic approaches provide better short-term outcomes compared to open surgery. However, the comparative effectiveness of robotic right colectomy and laparoscopic right colectomy in older patients remains uncertain.
Objective
This systematic review and meta-analysis aimed to evaluate the short-term outcomes of RRC versus LRC specifically in patients aged 65 and above, focusing on various surgical parameters and postoperative complications.
Methodology
The authors conducted a comprehensive literature search across multiple databases, including PubMed, Scopus, and the Cochrane Library, identifying prospective studies that compared RRC and LRC in the target age group. A total of 382 patients were included, with 157 undergoing RRC and 225 undergoing LRC. The primary outcomes evaluated included operative duration, conversion rates to laparotomy, intraoperative blood loss, and the number of retrieved lymph nodes. Secondary outcomes included overall post-surgical complications, wound infections, anastomotic leakage, length of hospitalisation, and rates of ileus.
Results
Key findings from the analysis revealed that RRC had a statistically significant increase in operative duration, averaging 43.91 minutes longer than LRC, although this was accompanied by high heterogeneity among studies (I² = 89%). Conversely, RRC showed a significant reduction in overall complications by 42% compared to LRC, indicating a favourable safety profile for robotic surgery in this demographic.
Non-significant differences were noted between the two approaches regarding the number of harvested lymph nodes, wound infections, length of hospitalization, and anastomotic leakage. Specifically, the rate of ileus was observed to be lower in RRC, although not reaching statistical significance.
Discussion
The findings suggest that while RRC necessitates a longer operative time, it is associated with reduced overall complications compared to LRC. The results align with some previous studies that indicated lower complication rates for RRC; however, they contrast with others that found no significant differences in postoperative outcomes. The authors emphasise the importance of considering surgeon experience and techniques, which could contribute to variability in outcomes.
Limitations
The study noted several limitations, including the small sample size and the non-randomised nature of the included studies, which may limit the generalisability of the findings. Additionally, high heterogeneity in some outcomes, particularly operative duration, suggests variability in surgical practices.
Conclusion
In conclusion, robotic right colectomy demonstrates lower complication rates compared to laparoscopic right colectomy but requires longer operative time. Given the limited number of studies available, particularly those focused on patients aged 65 and older, the authors advocate for further randomized controlled trials to substantiate these findings and explore long-term outcomes associated with both surgical approaches. This research is vital as the aging population continues to grow and the demand for effective surgical interventions for colorectal cancer increases.
READ MORE… https://link.springer.com/article/10.1007/s11701-025-02222-7
