Nationwide variations in the execution of minimally invasive right hemicolectomy and short-term outcomes: first phase of the RIGHT study

Although minimally invasive right hemicolectomy (MIRH) has become the standard of care to treat patients with right-sided colon cancer, substantial variation in the execution and implementation of proven beneficial elements that impact clinical outcomes exists. Within the Dutch national RIGHT project, a Delphi consensus was conducted that established an evidence-based, standardized technique for MIRH, including: low intra-abdominal pressure (IAP), complete mesocolic excision (CME) with central dissection along the superior mesenteric vein (SMV) and central vascular ligation (CVL) of segmental vessels, an intracorporeal anastomosis, and specimen extraction through a Pfannenstiel incision 1,2. The aim of the RIGHT project is to implement this standardized technique for MIRH nationwide in order to improve clinical outcomes. Within the first phase of the RIGHT study, the aim was to evaluate the nationwide variation of the elements of MIRH for right-sided colon cancer. The RIGHT study is a multicentre national prospective cohort study, that started in October 2021 in the Netherlands, with 43 participating hospitals (43 of 71 = 60.6% of Dutch hospitals). Patients undergoing planned MIRH (both conventional laparoscopic and robot-assisted) for right-sided non-locally advanced stage 1–3 colon cancer were included. During the first phase (October 2021—August 2022), participating surgeons were instructed to perform the MIRH according to their routine practice. An essential aspect of this study is that surgeons were required to make a video recording of the entire procedure and to take a picture of both the front and back of the specimen. The quality of mesocolic excision was scored according to Benz, ranging from 0 to 3, where a lower score indicates a more extensive mesocolic excision, with Benz 0 corresponding to CME3.