Comparative Outcomes of Open, Laparoscopic, and Robotic Right Colectomy for Colon Cancer: Postoperative Recovery, Surgical Quality, and 3-Year Survival—A Monocentric Retrospective Study

Background/Objectives: Minimally invasive approaches are increasingly used in right colectomy for colon cancer; however, comparative data, including open, laparoscopic, and robotic techniques, remain limited, particularly regarding postoperative recovery and oncological outcomes. Methods: This retrospective monocentric study included 89 patients undergoing elective right colectomy for colon cancer between July 2018 and December 2022. Of these, 30 patients underwent open, 29 laparoscopic, and 30 robotic-assisted surgery. The primary endpoint was postoperative recovery, defined as the time to first bowel movement. Secondary endpoints included length of hospital stay, complete mesocolic excision (CME) quality, lymph node yield, C-reactive protein (CRP) on postoperative day one, operative time, overall survival (OS), and disease-free survival (DFS). Multivariable regression analyses were performed adjusting for age, sex, BMI, ASA score, UICC stage, and tumor size. Results: Time to first bowel movement was shorter after minimally invasive surgery (median robotic 3.5, laparoscopic 4 vs. open 5 days) and length of hospital stay was numerically shorter (mean 9.1 vs. 10.1 days). CME quality and lymph node yield did not differ significantly between the approaches, and postoperative day-one CRP was numerically lower after robotic (median 4.9 mg/dL) and laparoscopic (5.1 mg/dL) than after open surgery (7.1 mg/dL), without reaching statistical significance after adjustment. Operative time was significantly longer with minimally invasive surgery (robotic +50 min; laparoscopic +43 min vs. open; both p < 0.001). Disease-free (open 51.6%, laparoscopic 66.5%, robotic 66.9%) and overall survival did not differ significantly after adjustment (robotic HR 1.16; laparoscopic HR 1.01 vs. open). Conclusions: No statistically significant difference in surgical quality between the approaches was detected, while operative time was significantly longer after minimally invasive surgery. No statistically significant independent association between the surgical approach and postoperative recovery or three-year oncological outcomes was detected; given the limited precision of the estimates, clinically important differences cannot be excluded.