Author response to: Comment on: Early outcomes from the Minimally Invasive Right Colectomy Anastomosis study (MIRCAST)

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Dear Editor Thanks to Kelm and Flemming1 for their comments on Gómez Ruiz et al.2 The topics discussed by Kelm and Flemming1 are relevant and are being explored in the MIRCAST study. The authors hope to complete the 2-year follow-up data collection at the end of this year and be able to publish the analysis in 2024. Although lymph node yield is an issue that has traditionally concerned every surgeon who performs right hemicolectomy procedures for the treatment of cancer, the impact on disease-free survival or local relapse is still unclear. It is also unclear whether lymphadenectomies that are more radical (such as D3 lymphadenectomies) improve survival and reduce local relapse. The MIRCAST study aims to evaluate these points. Regarding the MIRCAST study data published to date, the authors can say that robotic surgery facilitates the performance of D3 lymphadenectomies without increasing postoperative complications, but the authors will have to wait for the analysis of the 2-year follow-up to see if this translates into better oncological outcomes or not. All centres participating in the MIRCAST study used enhanced recovery after surgery (ERAS) protocols in the perioperative management of patients with high levels of compliance. It is possible to have a high degree of ERAS compliance (over 70%) without all the criteria being met. Some surgeons or hospitals use guidelines for perioperative pain management (supplementary lumbar analgesia, epidural analgesia, etc.) or bowel preparation (mechanical bowel preparation and/or oral or oral/intravenous antibiotic prophylaxis) that sometimes may not be fully compliant with current ERAS guidelines. In the observational setting of the MIRCAST study, this could not be controlled. The authors hope that their next publications on quality of life and mid-term outcomes for abdominal wall complications and oncological outcomes will help to answer the questions raised by Kelm and Flemming1. Eloy Espin-Basany, MD, PhD, Colorectal Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Antonino Spinelli, MD, PhD, IRCCS, Colorectal Surgery Unit, Humanitas Research Hospital, Humanitas University - Dept of Biomedical Sciences, Milan, Italy; Carmen Cagigas Fernández, MD, PhD, Colorectal Surgery Unit, Hospital Universitario Marqués de Valdecilla, Grupo de Investigación e Innovación en Cirugía, IDIVAL, Santander, Spain; Jesus Bollo Rodriguez, MD, PhD, Colorectal Surgery Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; José María Enriquez Navascués, MD, PhD, Colorectal Surgery Unit, Hospital Universitario Donostia, Donostia, Spain; Tero Rautio, MD, PhD, Colorectal Surgery Unit, Oulu University Hospital, Oulu, Finland; Mindaugas Tiskus, MD, Colorectal Surgery Unit, Hospital of Southern Denmark, Aabenraa, Denmark; Jorge Arredondo Chaves, MD, PhD, Colorectal Surgery Unit, Complejo Asistencial Universitario de León, León, Spain; Vicente Simó, MD, Colorectal Surgery Unit, Complejo Asistencial Universitario de León, León, Spain; Ugo Pace, MD, Colorectal Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Tarja Maria Pinta, MD, PhD, Colorectal Surgery Unit, Seinäjoki Central Hospital, Seinäjoki, Finland; Roberto Persiani, MD, Colorectal Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Roma, Italy; Andrea Coratti, MD, PhD, Colorectal Surgery Unit, Misericordia Hospital, Grosseto, Grosseto, Italy; Paolo Pietro Bianchi, MD, Colorectal Surgery Unit, Università di Milano, Milan, Italy; Wanda Luisa Petz, MD, Digestive Surgery - European Institute of Oncology – IRCCS, Milan, Italy; Fernando Jimenez Escobar, MD, Colorectal Surgery Unit, Hospital Galdakao Usansolo, Galdácano, Spain; Vincenzo Vigorita, MD, Colorectal Surgery Unit, University of Vigo, Vigo, Spain; Nuria Truan Alonso, MD, PhD, Colorectal Surgery Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Esther Kreisler Moreno, MD, PhD, Colorectal Surgery Unit, Hospital Universitario Bellvitge, Barcelona, Spain; Luis Miguel Jimenez Gomez, MD, PhD, Colorectal Surgery Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Alain Valverde, MD, Colorectal Surgery Unit, Hôpital de la Croix Saint Simon, Paris, France; Alejandro Romero de Diego, MD, Colorectal Surgery Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Philippe Rouanet, MD, PhD, Colorectal Surgery Unit, Institut du Cancer de Montpellier (ICM), Montpellier, France; Andreas Türler, MD, PhD, Colorectal Surgery Unit, Johanniter KH Bonn, Bonn, Germany; Antonio Arroyo, MD, PhD, Colorectal Surgery Unit, University Hospital of Elche, Elche, Spain; Ellen Van Eetvelde, MD, Colorectal Surgery Unit, UZ Brussel, Brussel, Belgium; Pälvi Vento, MD, PhD, Colorectal Surgery Unit, Kymenlaakso Central Hospital, Kotka, Finland; Ángel Reina Duarte, MD, PhD, Colorectal Surgery Unit, Hospital Universitario Torrecárdenas, Almería, Spain; Emre Balik, MD, PhD, Colorectal Surgery Unit, Koç University, Istanbul, Turkey; Andrea Muratore, MD, Colorectal Surgery Unit, Ospedale “Edoardo Agnelli” Pinerolo, Pinerolo, Italy; Jim Khan, MB BS, MSc, PhD, Colorectal Surgery Unit, Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom; Nuno Rama, MHSA, Colorectal Surgery Unit, Centro Hospitalar de Leiria, Leiria, Portugal; David Moro-Valdezate, MD, PhD, Colorectal Surgery Unit, University Clinic Hospital of Valencia, Valencia, Spain; Ismail Gögenur, DMSc, Colorectal Surgery Unit, Zealand University Hospital, Koge, Denmark; Juan Ocaña Jiménez, MD, Colorectal Surgery Unit, Hospital Ramón y Cajal, Madrid, Spain; Goran Šantak, MD, PhD, Colorectal Surgery Unit, County Hospital Požega, Požega, Croatia; Eric Rullier, MD, PhD, FASCRS, Colorectal Surgery Unit, CHU Bordeaux, Bordeaux, France; Irshad A. Shaikh, MD, Colorectal Surgery Unit, Norfolk & Norwich Univ Hospital NHS Foundation Trust, Norwich, United Kingdom; Roberto Coppola, MD, PhD, Surgery Unit, Campus Bio-Medico University, Roma, Italy; Fernando Mendoza, MD, PhD, Colorectal Surgery Unit, Hospital Universitario Príncipe de Asturias, Madrid, Spain; Luca Morelli, MD, PhD, Colorectal Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Benno Mann, MD, PhD, Colorectal Surgery Unit, Augusta Kliniken, Bochum, Germany; Matteo Frasson, PhD, FEBS-c, Colorectal Surgery Unit, University Hospital La Fe, University of Valencia, Spain, Valencia, Spain; Thalia Petropoulou, MD, PhD, FRCS, Colorectal Surgery Unit, Eurokliniki Athinou, Athens, Greece; Arto Turunen, MD, PhD, Colorectal Surgery Unit, Kanta-Hämeen keskussairaala, Hämeenlinna, Finland; Eduardo Ferrero Herrero, MD, PhD, Colorectal Surgery Unit, Hospital 12 de Octubre, Madrid, Spain; Jakob Lykke, MD, PhD, Colorectal Surgery Unit, Herlev University Hospital, Herlev, Denmark; Mauricio García Alonso, MD, PhD, Colorectal Surgery Unit, Hospital Clínico San Carlos, Madrid, Spain; Javier Sanchez Gonzalez, MD, PhD, Colorectal Surgery Unit, Hospital del Río Hortega, Valladolid, Spain; Anne Mattila, MD, PhD, Colorectal Surgery Unit, Central Finland Central Hospital, Jyväskylä, Finland; Francesk Mulita, MD, PhD, Colorectal Surgery Unit, General University Hospital of Patras, Patras, Greece; Julian Hance, MD, Colorectal Surgery Unit, St James's University Hospital, Leeds, United Kingdom; Bertrand Trilling, MD, PhD, Colorectal Surgery Unit, University Grenoble Hospital, Grenoble, France; Chiara Marafante, MD, Colorectal Surgery Unit, Ospedale degli Infermi di Rivoli, Turin, Italy; Markus Winny, MD, Colorectal Surgery Unit, Medizinische Hochschule Hannover, Hannover, Germany; Çağrı Büyükkasap, MD, Colorectal Surgery Unit, Gazi University Medical Faculty, Ankara, Turkey; Imma Prós Ribas, MD, Colorectal Surgery Unit, Fundació Hospital Sant Joan de Deu de Martorell, Martorell, Spain; Benoit Romain, MD, PhD, Colorectal Surgery Unit, Strasbourg University Hospital, Strasbourg, France; Kai Leong, MD, PhD, Colorectal Surgery Uni

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