VOLKAN ÖZBEN, Cansu DE MUİJNCK, Hasan Kürşad KORKMAZ, Hasan Can DEMİRKAYA, Ömer Faruk ERDİL, ERMAN AYTAÇ, BİLGİ BACA, TAYFUN KARAHASANOĞLU, İSMAİL HAKKI HAMZAOĞLU

Short term Outcomes of Robotic Complete Mesocolic Excision for the Surgical Treatment of Colon Cancer

INTRODUCTION: Since the description of complete mesocolic excision (CME) technique and use of robotic surgery, important advances have been made in the field of colorectal surgery in recent years. However, limited data exists regarding the feasibility of robotic surgery in the CME technique. In this study, we aimed to present the details of our operative technique and evaluate postoperative clinical outcomes in a series of patients undergoing robotic CME procedure. METHODS: Included in this study were 98 patients undergoing robotic CME for colon adenocarcinoma between November 2014 and May 2017. Patient data were recorded prospectively and reviewed retrospectively. Data on perioperative clinical findings, histopathologic data and postoperative 30-day outcomes were analyzed. RESULTS: There were 60 male (61.2%) and 38 female patients with a mean age of 64.4±12.2 years and body mass index of 27.3±4.6 kg/m2. In this series, sigmoid colon cancer was the most common (48.9%) and this was followed by right colon (23.5%), left colon (16.3%), transverse colon (%6.1) and synchronous cancers (5.1%). The mean operative time was 263.6±85.9 min and blood loss was 98.9±108.0 ml (median, 55 ml; range, 10-800 ml). Intraoperative complication occurred in 5 patients (5.1%). Two cases were converted to open surgery (2%). On histopathologic examination, all the surgical margins were clear and the mean number of harvested lymph nodes was 34.7±15.2. The mean time to first bowel movement and receiving oral solid diet were 3.5±1.3 and 3.5±1.7 days, respectively. The mean length of hospital stay was 6.3±2.6 days. The postoperative complication rate was 19.4%. DISCUSSION and CONCLUSION: For the surgical treatment of colon cancer, CME can be safely performed with the technical advantages of the robot. Robotic CME may provide accurate staging of the disease with a high number of harvested lymph nodes and this may translate into favorable oncologic outcomes.

Sol Kolon Kanserinin Cerrahi Tedavisinde Robotik Komplet Mezokolik Eksizyonun Kısa Dönem Sonuçları

GİRİŞ ve AMAÇ: Komplet mezokolik eksizyon (KME) tekniğinin tanımlanması ve robotik cerrahinin uygulanması ile son yıllarda kolorektal cerrahi alanında önemli gelişmeler kaydedilmiştir. Ancak, KME tekniğinde robotik cerrahinin uygulanabilirliği hakkında veri azdır. Bu çalışmada robotik KME uyguladığımız hasta serisi üzerinden ameliyatın teknik ayrıntılarını ve postoperatif sonuçları sunmayı amaçladık. YÖNTEM ve GEREÇLER: Çalışmaya Kasım 2014 ve Mayıs 2017 tarihleri arasında kolon adenokanseri nedeni ile robotik KME ameliyatı yapılan toplam 98 hasta alındı. Veriler prospektif olarak kayıt edildi ve retrospektif incelendi. Hastaların perioperatif klinik bulguları, histopatolojik verileri ve postoperatif ilk 30 gün sonuçları değerlendirildi. BULGULAR: Hastaların 60’ı (%61.2) erkek ve 38’si kadın, yaş ortalaması 64.4±12.2 yıl ve vücut kitle indeksi 27.3±4.6 kg/m2 idi. Serimizde en sık sigmoid kolon tümörü mevcuttu (%48.9), bunu sağ kolon (%23.5), sol kolon (%16.3), transvers kolon (%6.1) ve senkron yerleşimli tümörler (%5.1) izledi. Ortalama ameliyat süresi 263.6±85.9 dk ve kanama miktarı 98.9±108.0 ml (ortanca=55 ml, aralık=10-800 ml) idi. Toplam beş hastada (%5.1) intraoperatif komplikasyon gelişti. İki hastada (%2) açık cerrahiye geçildi. Histopatolojik incelemede hiçbir hastada cerrahi sınırlarda tümör saptanmadı ve çıkarılan ortalama lenf nodu sayısı 34.7±15.2 idi. İlk defekasyon ve oral katı gıda alımı için geçen süre sırasıyla 3.5±1.3 ve 3.5±1.7 gün ve ortalama hastanede yatış süresi 6.3±2.6 gün idi. Ameliyat sonrası komplikasyon %19.4 hastada gelişti. TARTIŞMA ve SONUÇ: Kolon kanserinin cerrahi tedavisinde KME robotun sağladığı teknik avantajlar sayesinde güvenle yapılabilir. Robotik KME daha yüksek sayıda lenf nodu çıkarılması ile daha doğru bir evreleme yapılmasını sağlayabilir ve onkolojik sonuçlara olumlu yönde katkıda bulunabilir.

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