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. 2021 Jun;12(3):944-952.
doi: 10.21037/jgo-21-221.

Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer-a propensity score-matching analysis

Tao Zhang  1 , Zijia Song  1 , Yaqi Zhang  1 , Xiaopin Ji  1 , Xiaoqian Jing  1 , Yi Shi  2 , Xi Cheng  1 , Ren Zhao  1
Affiliations

Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer-a propensity score-matching analysis

Tao Zhang et al. J Gastrointest Oncol. 2021 Jun.

Abstract

Background: Splenic flexure cancer (SFC) is a rare condition in colorectal cancer (CRC). The appropriate surgical treatment for SFC remains controversial. In recent years, we have used artery-guided segmental splenic flexure colectomy (ASFC) to treat SFC in which robotic access is gradually applied. The study sought to assess the clinical and oncologic outcomes of robotic-assisted ASFC compared to laparoscopic-assisted ASFC for SFC by undertaking a propensity score-matching analysis.

Methods: Seventy patients underwent a robotic-assisted ASFC (n=19) or laparoscopic-assisted ASFC (n=51) to treat SFC from Dec 2015 to Dec 2019. Their data were prospectively collected. The patients were matched at a ratio of 1:1 according to sex, age, body mass index (BMI), comorbidities, the American Society of Anesthesiologists (ASA) score (≤2 or >2), previous abdominal surgeries, and pathologic stage.

Results: No statistically significant differences were found between the robotic- and laparoscopic-assisted ASFC groups in relation to operation time, estimated blood loss, length of postoperative hospital stay, time to liquid diet, postoperative complications, tumor size, distal resection margins, histology, lymph node harvest, metastatic lymph nodes, and neuro-vascular invasion. Additionally, no case was converted to a laparotomy. There were no cases readmission or mortality within 30 days of surgery. The distal resection margins were longer in the robotic-assisted ASFC group than the laparoscopic-assisted ASFC group. The robotic-assisted ASFC group had significantly higher operation expenses than the laparoscopic-assisted ASFC group. However, there was no significant difference in the surgical material expenses between the two groups. There were 2 cases of complications in each group; both cases were classified as grade I or II under Dindo's classification of surgical complications.

Conclusions: With the exception of operation expenses, robotic-assisted ASFC rivals laparoscopic-assisted ASFC in many respects. ASFC meets the recommended oncological criteria in terms of resection margins and lymph node harvest. We await the results for the long-term oncologic outcomes.

Keywords: Splenic flexure cancer (SFC); artery-guided segmental splenic flexure colectomy; laparoscopic surgery; robotic-assisted surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-21-221). Dr. TZ reports funding from Youth Development Program of Ruijin Hospital, the Shanghai Jiaotong University School of Medicine [2019QNPY01010 (TZ)], and the Shanghai Charity Cancer Foundation (TZ). Dr. XC reports from National Natural Science Foundation of China [82002475 (XC)], and the Shanghai Sailing Program [20YF1427700 (XC)]. Dr. RZ reports funding from Shanghai Hospital Development Center [16CR2064B (RZ)] and Shanghai Municipal Health Construction Commission [201540026 (RZ)]. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Docking.
Figure 2
Figure 2
Port sites.
Figure 3
Figure 3
Specimen.
See this image and copyright information in PMC

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