• Marcos Gómez Ruiz, Eloy Espin-Basany, Antonino Spinelli, Cagigas FernándezCarmenCGrupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain., Jesus Bollo Rodriguez, José María Enriquez Navascués, Tero Rautio, Mindaugas Tiskus, and MIRCAST STUDY GROUP.
• Grupo de Investigación e Innovación en Cirugía, IDIVAL, Colorectal Surgery Unit, Marqués de Valdecilla University Hospital, Santander, Spain.
• Br J Surg. 2023 Aug 11; 110 (9): 115311601153-1160.

BackgroundThe impact of method of anastomosis and minimally invasive surgical technique on surgical and clinical outcomes after right hemicolectomy is uncertain. The aim of the MIRCAST study was to compare intracorporeal and extracorporeal anastomosis (ICA and ECA respectively), each using either a laparoscopic approach or robot-assisted surgery during right hemicolectomies for benign or malignant tumours.MethodsThis was an international, multicentre, prospective, observational, monitored, non-randomized, parallel, four-cohort study (laparoscopic ECA; laparoscopic ICA; robot-assisted ECA; robot-assisted ICA). High-volume surgeons (at least 30 minimally invasive right colectomy procedures/year) from 59 hospitals across 12 European countries treated patients over a 3-year interval The primary composite endpoint was 30-day success, defined by two measures of efficacy-absence of surgical wound infection and of any major complication within the first 30 days after surgery. Secondary outcomes were: overall complications, conversion rate, duration of operation, and number of lymph nodes harvested. Propensity score analysis was used for comparison of ICA with ECA, and robot-assisted surgery with laparoscopy.ResultsSome 1320 patients were included in an intention-to-treat analysis (laparoscopic ECA, 555; laparoscopic ICA, 356; robot-assisted ECA, 88; robot-assisted ICA, 321). No differences in the co-primary endpoint at 30 days after surgery were observed between cohorts (7.2 and 7.6 per cent in ECA and ICA groups respectively; 7.8 and 6.6 per cent in laparoscopic and robot-assisted groups). Lower overall complication rates were observed after ICA, specifically less ileus, and nausea and vomiting after robot-assisted procedures.ConclusionNo difference in the composite outcome of surgical wound infections and severe postoperative complications was found between intracorporeal versus extracorporeal anastomosis or laparoscopy versus robot-assisted surgery.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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