Robotic Right Colectomy with Complete Mesocolic Excision and Central Vascular Ligation. Extended Right Colectomy

Disease recurrence after right colectomy for stage II–III cancer is estimated to be up to 10% of cases. Complete mesocolic excision (CME) with central vascular ligation is a new concept of right colectomy aimed at removal of the diseased colon and its accessory lymphovascular supply by resecting the colon and mesocolon in an intact envelope of visceral peritoneum and ligating the feeding vessels along the route of superior mesenteric pedicle to maximize lymph node clearance. This technique has demonstrated interesting oncological outcomes, but the long-term results have yet to be definitively proved. The minimally invasive approach appears possible but challenging, and generally requires a long learning curve. The robotic technique offers more precise dissection and a shorter learning curve compared to conventional laparoscopy. The robotic approach is also particularly helpful when applied to obese patients. Prospective randomized studies with long-term follow-up and large series are required before recommending the CME technique and the robotic approach in routine practice.