Early outcomes after adopting robotic intracorporeal anastomosis for right hemicolectomy – a propensity-weighted analysis

To compare early outcomes of extracorporeal anastomosis (ECA) versus robotic intracorporeal anastomosis (ICA) in right hemicolectomy within a UK setting. We performed a retrospective cohort study of all minimally invasive right hemicolectomies at our institution between January 2023 and October 2025. The primary outcome was total length of recovery, defined as in‑hospital stay plus days enrolled in a “virtual hospital”. Secondary outcomes were operative time, postoperative inflammatory response (day‑1 C‑reactive protein, CRP), lymph node harvest, resection margin status, and postoperative complications (Clavien–Dindo). To account for baseline differences between groups, we applied inverse probability of treatment weighting (IPTW) based on preoperative demographic and clinical variables. A total of 163 patients were included: 100 undergoing ECA and 63 robotic ICA. After IPTW adjustment, ICA was associated with a significantly shorter total length of stay (RR 0.76, 95% CI 0.68–0.85; p < 0.001) and reduced in‑hospital stay (RR 0.48, 95% CI 0.42–0.54; p < 0.001). ICA required longer operative time (mean + 21 min, 95% CI 5.2–36.7; p = 0.009) but resulted in a lower day‑1 CRP (31.6 mg/L, 95% CI − 44.2 to − 18.9; p < 0.001). Lymph node yield was significantly higher with ICA in cancer patients (+ 2.6 nodes, 95% CI 0.68 to 4.47; p = 0.008), and R0 resection rates were comparable (OR 1.71, 95% CI 0.17 to 17.24; p = 0.649). Overall postoperative complications were significantly reduced in the ICA group (OR 0.30, 95% CI 0.16–0.55; p < 0.001). Robotic intracorporeal anastomosis for right hemicolectomy was associated with faster recovery and fewer complications than extracorporeal anastomosis, despite modestly increased operative time.