Robotic CME for Right-Sided Colon Cancer: Outcomes in Obese vs Non-Obese Patients

Overview

This study evaluated perioperative safety and oncological outcomes of robotic complete mesocolic excision (CME) for right-sided colon cancer in obese versus non-obese patients. Findings suggest that robotic CME can be performed safely with comparable outcomes regardless of obesity status.

Background

Colon cancer is a common malignancy worldwide, with standardized surgical approaches like complete mesocolic excision (CME) and extensive lymph node dissection offering improved prognosis. These procedures are technically challenging, especially in obese patients due to abundant visceral fat obscuring anatomical landmarks. Robotic surgery offers advantages that may overcome these challenges, but data on its efficacy in obese patients undergoing CME for right-sided colon cancer remain limited. This study aims to compare outcomes between obese and non-obese patients undergoing robotic CME using a standardized SMV-first approach.

Data Highlights

Key Findings

• Robotic CME for right-sided colon cancer was performed safely in both obese and non-obese patients with comparable perioperative morbidity.
• No significant difference in 30-day major complications (Clavien-Dindo grade III or higher) between obese and non-obese groups.
• Oncological outcomes including lymph node harvest, margin status, and pathological staging were similar regardless of obesity status.
• Survival analyses showed comparable overall survival and recurrence-free survival between obese and non-obese patients after robotic CME.
• Sex-stratified subgroup analyses indicated no significant interaction between sex and obesity on survival outcomes.
• Sensitivity analyses excluding complex cases (pT4b and multivisceral resections) confirmed robustness of findings.

Clinical Implications

Robotic CME using the SMV-first approach can be considered a safe and effective surgical option for right-sided colon cancer in obese patients, addressing previous concerns about technical difficulty and vascular injury risk. Surgeons experienced in robotic colorectal surgery may achieve comparable perioperative and oncologic outcomes in obese and non-obese populations, potentially expanding the use of CME in regions with high obesity prevalence.

Conclusion

Robotic complete mesocolic excision for right-sided colon cancer demonstrates comparable safety and oncological efficacy in obese and non-obese patients. These findings support the broader adoption of robotic CME irrespective of patient BMI.

References

1. Colon Cancer Global Incidence [1]
2. Standardized Surgical Approaches and Prognosis [2,3,4,5]
3. Obesity Prevalence in US Adults [6]
4. Robotic Surgery Advantages in Obese Patients [7,8,9,10]
5. SMV-First Robotic CME Approach [18]
6. Clavien-Dindo Classification [20]
7. Colorectal Cancer Recurrence Timing [21,22]
8. STROCSS Reporting Guidelines [19]