Analysis of surgical approach and tumor distance to margin after liver resection for colorectal liver metastasis

Shapera, Emanuel; Ross, Sharona; Crespo, Kaitlyn; Syblis, Cameron; Przetocki, Valerie; Rosemurgy, Alexander S.; Sucandy, Iswanto

doi:10.1007/s11701-022-01387-9

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…Studies on RLR vs LLR or OLR for CRLM have been extensively published in the past three years[ 45 , 46 , 61 - 63 ]. The evidence suggested RLR to have a lower conversion rate (RR = 0.42, 95%CI: 0.23 to 0.77; P = 0.005) and longer hospital stays (SMD = 0.19, 95%CI: 0.03 to 0.35; P = 0.020) than LLR for patients with CRLM, and there were no significant difference in operation time, estimated blood loss, intraoperative blood transfusion rates, R0 resection, postoperative morbidity, and overall survival[ 45 , 46 , 61 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…The evidence suggested RLR to have a lower conversion rate (RR = 0.42, 95%CI: 0.23 to 0.77; P = 0.005) and longer hospital stays (SMD = 0.19, 95%CI: 0.03 to 0.35; P = 0.020) than LLR for patients with CRLM, and there were no significant difference in operation time, estimated blood loss, intraoperative blood transfusion rates, R0 resection, postoperative morbidity, and overall survival[ 45 , 46 , 61 , 62 ]. In addition, limited evidence showed there were no significant differences in operation time, estimated blood loss, R0 resection, hospital stays, overall complications, minor and major complications, postoperative 30-d mortality, and survival outcomes between RLR and OLR for patients with CRLM[ 61 , 63 ]. With appropriate expertise and experience, robotic-assisted surgery can be considered to be an alternative minimally invasive approach to CRLM resections[ 64 , 65 ].…”

Section: Resultsmentioning

confidence: 99%

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International experts consensus guidelines on robotic liver resection in 2023

Liu,

Hilal,

Wakabayashi

et al. 2023

World J Gastroenterol

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The robotic liver resection (RLR) has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system, however, controversies still exist. Based on the foundation of the previous consensus statement, this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice. The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine (EBM). Relevant literature was reviewed and analyzed by the evidence evaluation group. According to the WHO Handbook for Guideline Development, the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022, a total of 14 recommendations were generated. Among them were 8 recommendations formulated by the GRADE method, and the remaining 6 recommendations were formulated based on literature review and experts’ opinion due to insufficient EBM results. This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

International experts consensus guidelines on robotic liver resection in 2023

Liu,

Hilal,

Wakabayashi

et al. 2023

World J Gastroenterol

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“…This study, SIMMILR-2, aimed to assess whether any differences can be found in a comparison of these three surgical approaches in terms of long-term outcomes, namely, overall survival (OS) and recurrence-free survival (RFS). Data exist comparing OLR and LLR but are limited to short-term outcomes, with oncological data limited to showing the equivalency of resection margin status [ 4 ]; similarly, short-term outcomes [ 5 , 6 ] and margin status have been compared between OLR and RLR for CRLM, with similar results seen in both groups [ 7 , 8 ]. Due to the great disparity in how studies and data are reported, with synchronous and metachronous lesions often being reported together, we only included data from patients who presented with synchronous lesions, and we controlled for neoadjuvant chemotherapeutic and biological treatments received.…”

Section: Introductionmentioning

confidence: 99%

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

Gumbs

Croner

Lorenz

et al. 2022

Cancers

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Introduction: Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-CRLM) was a propensity score matched (PSM) study that reported short-term outcomes of patients with CRLM who met the Milan criteria and underwent either open (OLR), laparoscopic (LLR) or robotic liver resection (RLR). This study, designated as SIMMILR-2, reports the long-term outcomes from that initial study, now referred to as SIMMILR-1. Methods: Data regarding neoadjuvant chemotherapeutic (NC) and neoadjuvant biological (NB) treatments received were collected, and Kaplan–Meier curves reporting the 5-year overall (OS) and recurrence-free survival (RFS) for OLR, LLR and RLR were created for patients who presented with synchronous lesions only, as there was insufficient follow-up for patients with metachronous lesions. Results: A total of 73% of patients received NC and 38% received NB in the OLR group compared to 70% and 28% in the LLR group, respectively (p = 0.5 and p = 0.08). A total of 82% of patients received NC and 40% received NB in the OLR group compared to 86% and 32% in the RLR group, respectively (p > 0.05). A total of 71% of patients received NC and 53% received NB in the LLR group compared to 71% and 47% in the RLR group, respectively (p > 0.05). OS at 5 years was 34.8% after OLR compared to 37.1% after LLR (p = 0.4), 34.3% after OLR compared to 46.9% after RLR (p = 0.4) and 30.3% after LLR compared to 46.9% after RLR (p = 0.9). RFS at 5 years was 12.1% after OLR compared to 20.7% after LLR (p = 0.6), 33.3% after OLR compared to 26.3% after RLR (p = 0.6) and 22.7% after LLR compared to 34.6% after RLR (p = 0.6). Conclusions: When comparing OLR, LLR and RLR, the OS and RFS were all similar after utilization of the Milan criteria and PSM. Biological agents tended to be utilized more in the OLR group when compared to the LLR group, suggesting that highly aggressive tumors are still managed through an open approach.

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“…Colorectal cancer is a common malignant disease, which is known to cause metastasis to the liver in about 50% of patients. 1 Surgical resection to achieve R-0 margins is the goal of treatment in combination with systemic chemotherapy. While complete liver resection to remove metastatic lesions significantly improves overall survival, preserving noncancerous liver parenchyma is crucial for several reasons.…”

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confidence: 99%

Open Parenchymal Sparing Posterosuperior Liver Tumor Resection for Colorectal Liver Metastasis With Proximity to Hepatic Veins

Younos

Touadi

Ross

et al. 2023

The American Surgeon™

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Liver resection for stage 4 colorectal cancer with liver metastasis is the standard of care, in combination with systemic chemotherapy. R-0 complete resection for colorectal liver metastasis is a curative-intent operation, which is considered the only chance for cure in this disease. The location and proximity of the tumor to major intrahepatic vessels such as hepatic and portal vein determine technical difficulty. Tumors located in the posterosuperior segments of the liver (segments 7 and 8) are technically challenging to resect using a minimally invasive fashion; therefore, conventional open resection is still the technique of choice today. In this video, we demonstrated our approach of an open parenchymal-sparing posterosuperior liver resection for a colorectal liver metastasis.

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Analysis of surgical approach and tumor distance to margin after liver resection for colorectal liver metastasis

Cited by 9 publications

References 24 publications

International experts consensus guidelines on robotic liver resection in 2023

International experts consensus guidelines on robotic liver resection in 2023

Survival Study: International Multicentric Minimally Invasive Liver Resection for Colorectal Liver Metastases (SIMMILR-2)

Open Parenchymal Sparing Posterosuperior Liver Tumor Resection for Colorectal Liver Metastasis With Proximity to Hepatic Veins

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