Robotic colon surgery in obese patients: a systematic review and meta‐analysis

• Published in: ANZ journal of surgery 2023-01, Vol.93 (1-2), p.35-41
• Main Authors: Wang, Jason, Johnson, Nicholas W., Casey, Laura, Carne, Peter W. G., Bell, Stephen, Chin, Martin, Simpson, Paul, Kong, Joseph C.
• Format: Article
• Language: English
• Subjects: Anastomotic leak; Anastomotic Leak - epidemiology; Colon; Colon cancer; colorectal; Colorectal surgery; Complications; Humans; Infectious diseases; laparoscopic; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Lymph nodes; Meta-analysis; obesity; Obesity - complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Robotic surgery; robotic surgical procedures; Robotic Surgical Procedures - adverse effects; Robotics; Surgical anastomosis; Surgical site infections; Surgical Wound Infection - complications; Systematic review; Treatment Outcome
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.17749

Background Colon cancer resection can be technically difficult in the obese (OB) population. Robotic surgery is a promising technique but its benefits remain uncertain in OB patients. The aim of this study is to compare OB versus non‐obese (NOB) patients undergoing robotic colon surgery, as well as OB patients undergoing robotic versus open or laparoscopic colonic surgery. Methods A systematic review and meta‐analysis was performed. Primary outcome measures included length of stay (LOS), surgical site infection (SSI) rate, complications, anastomotic leak and oncological outcomes. Results A total of eight studies were included, with five comparing OB and NOB patients undergoing robotic colon surgery included in meta‐analysis. A total of 263 OB patients and 400 NOB patients formed the sample for meta‐analysis. There was no significant difference between the two groups in operative time, conversion to open, LOS, lymph node yield, anastomotic leak and postoperative ileus. There was a trend towards a significant increase in overall complications and SSI in the OB group (32.3% OB versus 26.8% NOB for complications, 14.2% OB versus 9.9% NOB for SSI). The three included studies comparing surgical techniques were too heterogeneous to undergo meta‐analysis. Conclusion Robotic colon surgery is safe in obese patients, but high‐quality prospective evidence is lacking. Future studies should report on oncological safety and the cost‐effectiveness of adopting the robotic technique in these challenging patients. This systematic review and meta‐analysis of obese patients undergoing robotic colon surgery has demonstrated the safety and potential benefit of the robotic technique. Future prospective studies should focus on cost‐effectiveness and long‐term oncological outcomes.