Lymph node yield in right colectomies for cancer: A comparison of open, laparoscopic and robotic approaches

Aim Studies have demonstrated a relationship between lymph node (LN) yield and survival after colectomy for cancer. The impact of surgical technique on lymph node yield has not been well explored. Method This is a retrospective study of right colectomies (RC) for cancer at a single institution from 2012-2014. Exclusion criteria were previous colectomy, emergent and palliative operations. All data were collected by chart review. Primary outcomes were LN yield and the lymph node to length of surgical specimen (LN-LSS) ratio. Multivariable mixed models were created with surgeon and pathologist as random effects. Sensitivity analyses were performed to exclude stage IV cancers and to analyze groups on an “as-treated” basis. Results We identified 181 open (O-RC), 163 laparoscopic (L-RC) and 119 robotic (R-RC) cases. Open RC was more commonly performed in females with metastatic disease. Mean LN yield was 28, 29, and 34 in O-RC, L-RC, and R-RC, respectively; mean LN-LSS ratios were 0.83, 0.91 and 1.0. The R-RC approach produced a higher LN yield compared to other approaches (p