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Robotic right versus left colectomy for colon neoplasm: A systemic review and meta-analysis

To be presented at
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2023. Montréal, Canada
Andrea Solis- Pazmino, Kimberly Oka, Kristina La, Oscar Ponce, Jason Cohen, Moshe Barnajian, Yosef Nasseri

Previous studies comparing right and left colectomies have shown variable short-term outcomes. Despite the rapid adoption of robotics in colorectal operations, few studies have addressed outcome differences between robotic right (RR) and left (RL) colectomies. Therefore,we sought to compare short term outcomes of RR and RL colectomies for cancer.

This is a systematic review and meta-analysis of articles published from the time of inception of the datasets to May 1, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, OvidEMBASE, and Scopus.

A total of 13,514 patients with colon neoplasia enrolled in 9 comparative studies were included. The overall mean age was 64.1 years, (standard deviation [SD] ± 9.8), and there was a minor female predominance (52% female vs. 48% male). 8,656 (64.0 %) underwent RR and 4,858 (36.0 %) underwent RL colectomies. The ASA score 1-2 in the LR group was 37% vs 21% in RR. Whereas the ASA score 3-4 was 62% in the LR vs 76% in RR. Moreover, the mean of the Charlson Comorbidity Score in the LR was 4.3 (SD 1.9) vs 3.1 (SD 2.3) in the RR. Meta-analysis revealed a significantly higher rate of ileus in RR (10%) compared to RL (7%) colectomy (OR 0.69, 95% CI 0.60- 0.79). Additionally, operative time was significantly longer by 22.6 minutes in RL versus RR (95%CI 7.8- 37.4; p< 0.001). There were no statistically significant differences between RR an RL in conversion to open operation, estimated blood loss, wound infection, anastomotic leak, reoperation, readmission, and hospital length of stay.

In this only meta-analysis comparing RR and RL colectomies for cancer, we found that RR was independently associated with a shorter operative time but increased risk of ileus.