Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-018-6592-3 REVIEW ARTICLE Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach Emanuele Rausa 1  · Michael Eamon Kelly 2  · Emanuele Asti 1  · Alberto Aiolf 1  · Gianluca Bonitta 1  · Luigi Bonavina 1 Received: 9 May 2018 / Accepted: 13 November 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background There are a variety of surgical approaches for the management of right-sided colonic neoplasms. To date, no method has been shown superior in terms of surgical and perioperative outcomes. This meta-analysis compared open (ORH), laparoscopic-assisted (LRH), total laparoscopic (TLRH), and robotic right hemicolectomy (RRH) to assess surgical outcomes and perioperative morbidity and mortality. Study design We conducted an electronic systematic search using PubMed, EMBASE, and Web of Science that compared RRH, TLRH, LRH, and ORH. Forty-eight studies met the inclusion criteria: 5 randomized controlled trials, 25 retrospective, and 18 prospective studies totalling 5652 patients were included. Results The overall complication rate was similar between RRH and TLRH (RR 1.0; Crl 0.66–1.5). The anastomotic leak rate was higher in LRH and ORH compared to RRH (RR 1.9; Crl 0.99–3.6 and RR 1.2; Crl 0.55–2.6, respectively), whereas it was lower in TLRH compared to RRH (RR 0.88 Crl 0.41–1.9). The risk of reoperation was signifcantly higher in ORH compared to TLRH (RR 3.3; Crl 1.3–8.0). Operative time was similar in RRH compared to LRH (RR − 27.0; Crl − 61.0 to 5.9), and to TLRH (RR − 24.0; Crl − 70.0 to 21.0). The hospital stay was signifcantly longer in LRH compared to RRH (RR 3.7; Crl 0.7–6.7). Conclusion The surgical management of right-sided colonic disease is evolving. This network meta-analysis observed that short-term outcomes following RRH and TLRH were superior to standard LRH and ORH. The adoption of more advanced minimally invasive techniques can be costly and have associated learning phases, but will ultimately improve patient outcomes. Keywords Right hemicolectomy · Robotic surgery · Laparoscopy · Postoperative complications · Cost analysis Colorectal is the third most common malignancy afecting the population worldwide. Surgery remains the cornerstone of treatment. In contemporary times, the optimal surgical approach for right resections is often debated [1]. Increas- ingly, there is focus on the incidence of postoperative com- plications, quality of life, and oncological outcomes [2]. Laparoscopic colonic resection was first introduced in 1991 [3]. Currently, laparoscopy is the most common utilized approach across colorectal surgery, as it is associ- ated with reduced complications, shorter length of hospi- tal stay, due to earlier mobilization, and return to normal bowel function, with comparable oncological outcomes [4]. Nevertheless the standardization of the technique, particu- larly pertaining to the ileocolic anastomosis (extracorporeal [laparoscopic-assisted right hemicolectomy (LRH)] versus intracorporeal [total laparoscopic hemicolectomy (TLRH)]), has not been internationally agreed [5]. This represents a considerable confounder when comparing operative tech- niques across the literature [6]. Recent developments, most notably the introduction of the robotic platforms (da Vinci robot Intuitive Surgical Inc, Sunnyvale, CA, USA) [7], have increased focus on mini- mally invasive approaches to both colonic and rectal dis- section and anastomosis. Robotic technology is proposed to overcome ergonomical issues associated with laparoscopic and Other Interventional Techniques * Emanuele Rausa emarausa@yahoo.it 1 Division of General Surgery, Department of Biomedical Sciences of Health, IRCCS Policlinico San Donato, University of Milan Medical School, San Donato Milanese, Milan, Italy 2 Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland