Robotic Right Hemicolectomy Provides Equivalent Oncologic Outcomes and Improved Perioperative Recovery Compared with Open Surgery.

Background/objectives: Open right hemicolectomy (ORH) remains the standard approach for locally advanced right-sided colon cancer. Minimally invasive techniques are increasingly applied in earlier disease stages; however, evidence regarding long-term oncologic outcomes in advanced tumors remains limited. This study aimed to compare the perioperative and oncologic outcomes of ORH versus robotic right hemicolectomy (RRH). Methods: In this single-center study, a prospectively maintained database of consecutive right hemicolectomy patients (2010-2020) was analyzed. The primary endpoint was overall survival (OS). Secondary endpoints included disease-free survival (DFS), perioperative outcomes, and histopathological quality. Additionally, a subgroup analysis was performed for T4 tumors. Results: A total of 198 patients was included, comprising 77 that underwent ORH and 121 that underwent RRH. RRH achieved oncologic outcomes comparable with ORH, with similar R0 resection rates (96% vs. 97.5%, p = 0.547) and lymph node yields (median of 18 nodes in both groups, p = 0.828). OS did not differ significantly (ORH, 45.3 months vs. RRH, 49.9 months, p = 0.130). DFS was longer in RRH (ORH, 42.2 months vs. RRH, 49.1 months, p = 0.029; HR = 0.575, 95% CI 0.349-0.947); however, this difference disappeared after adjustment for tumor stage. No survival advantage was observed in the T4 subgroup. Conclusions: RRH provides oncologic outcomes comparable to open surgery while offering perioperative advantages, even in locally advanced colon cancer. When performed in experienced high-volume centers, RRH represents a safe and oncologically sound alternative to ORH and may contribute to expanding MIC beyond early-stage disease.