A Retrospective Observational Study Comparing Short-Term Outcomes in Intracorporeal vs Extracorporeal Robotic Right Hemicolectomy

Background Robotic right hemicolectomy is increasingly performed for neoplastic disease, but the optimal method of anastomosis remains debated. Intracorporeal anastomosis (ICA) may offer advantages in reducing wound complications and postoperative ileus, while extracorporeal anastomosis (ECA) is technically simpler. Evidence specific to oncologic populations, however, is limited. Methods We conducted a retrospective observational study of patients undergoing robotic right hemicolectomy for neoplastic pathology at a tertiary academic centre between January 2023 and December 2024. Patients were stratified into ICA and ECA groups. Primary outcomes included early postoperative recovery (time to bowel movement, anastomotic leak, and 30-day readmission). Secondary outcomes assessed operative time, wound complications, postoperative ileus, systemic inflammatory response (C-reactive protein (CRP) and white cell count (WCC)), length of stay, and oncologic adequacy (lymph node harvest, tumour staging). Statistical analyses included t-test, Mann-Whitney U test, chi-square test, or Fisher’s exact test, with significance set at p <0.05. Results Eighty-three patients were included: 61 (73.5%) underwent ICA, and 22 (26.5%) underwent ECA. Baseline demographics, body mass index (BMI), and prior abdominal surgery rates were comparable between groups. ICA was associated with longer operative time (176.1 vs 153.7 minutes, p = 0.06). Anastomotic leaks were rare (ICA 2/61, 3.3%; ECA 0/22; p = 1.0). Wound infections occurred only in the ECA group (13.6% vs 0%, p = 0.02), and postoperative ileus was more frequent with ECA (13.6% vs 0%, p = 0.02). Readmission rates were similar (ICA 9.8% vs ECA 9.1%, p = 1.0). There were no significant differences in systemic inflammatory markers or length of hospital stay. Lymph node yield (24.9 vs 22.4, p = 0.33) and tumour stage distribution were comparable, confirming oncologic adequacy. One postoperative death occurred in the ICA group, unrelated to anastomotic integrity. Conclusion In robotic right hemicolectomy for neoplastic disease, ICA was associated with lower rates of wound infection and postoperative ileus compared with ECA, without increased leak rates or compromise in oncologic adequacy. Despite slightly longer operative times, ICA demonstrated favourable short-term morbidity. Prospective multicentre studies are warranted to confirm these findings and guide surgical decision-making in colorectal oncology.