Comparison of surgical outcomes of robotic complete mesocolic excision for right-sided colon cancer in obese versus non-obese patients.

BACKGROUND

A major concern of complete mesocolic excision (CME) for right-sided colon cancer is whether it can be performed safely in obese patients. The aim of this study is to perform a contemporary evaluation of the perioperative safety and oncological outcomes of robotic CME for right-sided colon cancer in obese versus non-obese patients.

METHODS

This was a single-institution retrospective cohort study of patients who underwent robotic CME for right-sided colon cancer between 2015 and 2023. Patients were divided into obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) groups. Perioperative complications, operative metrics, pathological results, overall survival (OS), and recurrence-free survival (RFS) were compared.

RESULTS

Of 211 patients, 80 (37.9%) were obese. Complication rates did not differ significantly between obese and non-obese groups (any grade: 18.8% vs 12.2%, P = 0.24; grade III: 3.8% vs 1.5%, P = 0.30). No vascular injuries occurred in either group. Conversion rates (5.0% vs 0.8%, P = 0.05) and length of stay were similar. Obese patients had longer operative times (289.5 vs 247 min, P = 0.003) and greater blood loss (50 vs 30 mL, P = 0.025). No cases had positive circumferential resection margins. Lymph node harvest (34.5 vs 34 nodes, P = 0.85) and margin status were comparable. During median follow-up of 2.6 years, 3-year RFS was similar between groups (89.1% vs 86.7%, P = 0.63), with no significant differences in OS (100% vs 95.6%, P = 0.13).

CONCLUSIONS

Obesity was associated with longer operative times and increased blood loss but not with higher complication rates or worse survival outcomes. Robotic CME appears technically and oncologically feasible for both obese and non-obese patients with right-sided colon cancer.