Efficacy analysis of robotic versus laparoscopic‑assisted right hemicolectomy

Objective To investigate the short‑term efficacy of robotic versus laparoscopic-assisted right hemicolectomy.

Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 99 patients of right colon cancer who were admitted to Tianjin Medical University General Hospital from January 2020 to December 2023 were collected. There were 50 males and 49 females, aged 69(range, 26‒89)years. Of the 99 patients, 41 patients undergoing robotic‑assisted right hemicolectomy were divided into the robotic group, and 58 patients undergoing laparoscopic‑assisted right hemicolectomy were divided into the lapa-roscopic group. Patients received robotic-assisted or laparoscopic-assisted right hemicolectomy operated by the same major surgeon. Observation indicators:(1) propensity score matching status and com-parison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶1 nearest neighbor matching method. The caliper value was set as 0.1.

Results (1) Propensity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 99 patients, 82 patients were successfully matched, with 41 cases in each of the robotic group and the laparoscopic group. After propensity score matching, the elimination of history of abdominal operation confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After propensity score matching, the operation time of the robotic group was 215(range, 130‒340)minutes, the volume of intraoperative blood loss was 50(range, 10‒400)mL, the number of lymph node dissected was 21(range, 5‒55), the number of intensive care unit stay was 15, time to postoperative first flatus was 3(range, 1‒12)days, time to postoperative first food intake was 4(range, 2‒14)days, duration of postoperative hospital stay was 8(range, 5‒25)days. The above indicators of the laparoscopic group were 210(range, 140‒370)minutes, 50(range, 5‒150)mL, 19(range, 5‒34),20, 3(range, 0‒9)days, 5(range, 2‒10)days, 8(range, 6‒17)days, respectively. There was no significant difference in the above indicators between patients of the two groups (Z=‒0.94, ‒1.87, ‒1.32, χ²=1.25, Z=0.13, ‒0.83, ‒0.65, P>0.05). There was no patient converted to open operation in the robotic group, versus 1 patient converted to open operation in the laparoscopic group, showing no significant difference between patients of the two groups (P>0.05). There were 6 cases in the robotic group and 4 cases in the laparoscopic group with complications, showing no significant difference between the two groups (χ²=0.46, P>0.05). Both groups of patients achieved R₀ resection and had no readmission 30 days after surgery. The hospital expense was (11.0±1.8)×10⁴ yuan of the robotic group, versus (9.0±1.7)×10⁴ yuan of the laparoscopic group, showing a significant difference between the two groups (t=‒5.27, P<0.05).

Conclusion Robot‑assisted right hemicolectomy is non inferior to laparoscopic-assisted right hemicolectomy in safety and efficacy, but with higher hospitalization costs.