Minimally invasive robotic-assisted combined colorectal and liver excision surgery: feasibility, safety and surgical technique in a pilot series

Ceccarelli, Graziano; Rocca, Aldo; Rosa, Michele De; Fontani, Andrea; Ermili, Fabio; Andolfi, Enrico; Bugiantella, Walter; Sandri, Giovanni Battista Levi

doi:10.1007/s13304-021-01009-3

Cited by 27 publications

(43 citation statements)

References 33 publications

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“…Only the paper by Ceccarelli et al 25 According to Brisbane classification, hepatic resections were classified as major if more of three segments were ablated. 34 Thirtyeight major resections were performed (14.5% of patients), in 15 cases simultaneously to primary cancer resection.…”

Section: Resultsmentioning

confidence: 99%

“…25,26,31 Four series reported the OS outcomes: the 1-year OS rate was 90.4-100%, the 3-year OS was 44.4-66.1% and the 5-year OS was 37.0-61.0%. 25,26,28,31 Five series reported the DFS outcomes: the 1-year DFS was 44.4-89.5%, the 3-year DFS was 33.3-41.9% and the 5-year DFS was 38.0%. 26,28,29,31,32 Post-operative data are summarized in Table 5.…”

Section: Resultsmentioning

confidence: 99%

“…41,44,64,[67][68][69][70][71] Excluding Beard et al, eight of the nine authors cited in this review respect the R0 standard of care achieving a cancer free margin specimens in more than 90% of cases. 9,25,[28][29][30][31][32][33] The laparoscopic resections for CRLMs showed a mean hospital stay of 4.5 days. [51][52][53] Indeed, the open liver surgery for CRLM demonstrates a hospital stay of 6.87 days as mean, while the robotic approach showed a longer hospital stay of 7.98 days as mean.…”

Section: Complicationsmentioning

confidence: 99%

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Robotic surgery for colorectal liver metastases resection: A systematic review

Rocca

Scacchi

Cappuccio

et al. 2021

Robotics Computer Surgery

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Background:The role of robotic surgery for colorectal cancer liver metastases (CRCLMs) has never been investigated in large series.Methods: A systematic literature review was carried out on PubMed and Cochrane libraries. Results:We selected nine studies between 2008 and 2021. Two hundred sixty-two patients were included. One hundred thirty-one patients underwent simultaneous resections. The mean blood loss was 309.4 ml (range, 200-450 ml), the mean operative time was 250.5 min (range, 198.5-449.0 min). The mean length of hospital stay was 7.98 days (range, 4.5 to 12 days). The overall postoperative mortality was 0.4%. The overall morbidity rate was 37.0%, Clavien-Dindo grade III-IV complications were 8.4%. The mean 3-year overall survival was 55.25% (range, 44.4-66.1%), the mean 3-year disease free survival was 37% (range, 33.3-41.9%) Conclusion:We can conclude that robotic-assisted surgery might be considered as a technical upgrade option for minimally invasive approach to CRCLM resections even for simultaneous operations and challenging cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Robotic surgery for colorectal liver metastases resection: A systematic review

Rocca

Scacchi

Cappuccio

et al. 2021

Robotics Computer Surgery

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“…Like other minimally invasive operations that have been compared to their open counterparts, minimally invasive liver resection is also often associated with lower blood loss and shorter hospital stay [ 100 ]. Combined minimally invasive colorectal and liver excision surgery is also feasible and safe but requires an expert surgical team in both minimally invasive colorectal and liver surgery [ 101 ].…”

Section: Minimally Invasive Liver Resectionmentioning

confidence: 99%

Current Surgical Management Strategies for Colorectal Cancer Liver Metastases

Ivey

Johnston

Azad

et al. 2022

Cancers

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Colorectal cancer is the third most common cancer diagnosis in the world, and the second most common cause of cancer-related deaths. Despite significant progress in management strategies for colorectal cancer over the last several decades, metastatic disease remains difficult to treat and is often considered incurable. However, for patients with colorectal liver metastases (CRLM), surgical resection offers the best opportunity for survival, can be curative, and remains the gold standard. Unfortunately, surgical treatment options are underutilized. Misperceptions regarding resectable and unresectable CRLM likely play a role in this. The assessment of factors that impact resectability status like medical fitness, technical considerations, and disease biology can be difficult, necessitating careful multidisciplinary input and discussion. The identification of ideal operative time windows that align with the multimodal management of these patients can also be perplexing. For all patients with CRLM it may therefore be advantageous to obtain surgical evaluation at the time of discovering liver metastases to mitigate these challenges and minimize the risk of undertreatment. In this review we summarize current surgical management strategies for CRLM and discuss factors to be considered when determining resectability.

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“…To date, the R0 surgical resection of liver metastases is still considered the best treatment for curative purposes [ 11 ]. In recent years, the new parenchyma sparing techniques and the accurate ultrasound-guided liver resections allow even more wide surgical indications and the possibility of further surgery also in case of recurrence [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Early Diagnosis of Liver Metastases from Colorectal Cancer through CT Radiomics and Formal Methods: A Pilot Study

Rocca

Brunese

Santone

et al. 2021

JCM

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Background: Liver metastases are a leading cause of cancer-associated deaths in patients affected by colorectal cancer (CRC). The multidisciplinary strategy to treat CRC is more effective when the radiological diagnosis is accurate and early. Despite the evolving technologies in radiological accuracy, the radiological diagnosis of Colorectal Cancer Liver Metastases (CRCLM) is still a key point. The aim of our study was to define a new patient representation different by Artificial Intelligence models, using Formal Methods (FMs), to help clinicians to predict the presence of liver metastasis when still undetectable using the standard protocols. Methods: We retrospectively reviewed from 2013 to 2020 the CT scan of nine patients affected by CRC who would develop liver lesions within 4 months and 8 years. Seven patients developed liver metastases after primary staging before any liver surgery, and two patients were enrolled after R0 liver resection. Twenty-one patients were enrolled as the case control group (CCG). Regions of Interest (ROIs) were identified through manual segmentation on the medical images including only liver parenchyma and eventual benign lesions, avoiding major vessels and biliary ducts. Our predictive model was built based on formally verified radiomic features. Results: The precision of our methods is 100%, scheduling patients as positive only if they will be affected by CRCLM, showing a 93.3% overall accuracy. Recall was 77.8%. Conclusion: FMs can provide an effective early detection of CRCLM before clinical diagnosis only through non-invasive radiomic features even in very heterogeneous and small clinical samples.

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Minimally invasive robotic-assisted combined colorectal and liver excision surgery: feasibility, safety and surgical technique in a pilot series

Cited by 27 publications

References 33 publications

Robotic surgery for colorectal liver metastases resection: A systematic review

Robotic surgery for colorectal liver metastases resection: A systematic review

Current Surgical Management Strategies for Colorectal Cancer Liver Metastases

Early Diagnosis of Liver Metastases from Colorectal Cancer through CT Radiomics and Formal Methods: A Pilot Study

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