Feasibility and Short-term Outcomes of Robotic Surgery for Transverse Colon Cancer: A Multicenter Retrospective Study

Background/Aim: Patients with transverse colon cancer have been excluded from randomized controlled trials due to its anatomical complexity and high technical difficulty. Few studies have compared robotic surgery with laparoscopic or open surgery for transverse colon cancer. We conducted a comparative analysis of the safety and efficacy of robotic surgery for transverse colon cancer. Patients and Methods: We retrospectively reviewed 635 patients treated for transverse colon cancer between 2016 and 2025. Patients were categorized according to the surgical approach: robotic surgery (Robot group, n=38), laparoscopic surgery (Lap group, n=530), and open surgery (Open group, n=67). Clinicopathological and surgical features were compared between groups. Results: Operative time was longer (Robot vs. Lap vs. Open; 233 vs. 226 vs. 181 min, p<0.001), blood loss was lower (15 vs. 20 vs. 120 ml, p<0.001), more lymph nodes were retrieved (19 vs. 16 vs. 10, p=0.002), and hospital stay was shorter (9 vs. 12 vs. 22 days, p<0.001) in the Robot group. The postoperative complication rate tended to be lower in the Robot group (7.9% vs. 23.2% vs. 25.4%, p=0.077). In multivariate analysis, male sex (OR=1.559, 95% CI=1.056-2.301, p=0.025) and ASA-PS 3 (OR=2.486, 95% CI=1.460-4.232, p<0.001) were identified as independent risk factors for postoperative complications. Conclusion: Although favorable short-term outcomes were observed in this small, highly selected robotic cohort, these descriptive findings do not establish the clinical superiority or equivalence of robotic surgery over laparoscopic or open surgery. Larger prospective studies are needed to define its oncological and surgical value.