Outcomes of robotic liver resections for colorectal liver metastases. A multi-institutional analysis of minimally invasive ultrasound-guided robotic surgery

Guerra, Francesco; Guadagni, Simone; Pesi, Benedetta; Furbetta, Niccolò; Franco, Gregorio Di; Palmeri, Matteo; Annecchiarico, Mario; Eugeni, Emilio; Coratti, Andrea; Patriti, Alberto; Morelli, Luca

doi:10.1016/j.suronc.2018.10.011

Cited by 35 publications

(46 citation statements)

References 29 publications

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“…Furthermore, another multicenter study figured out a 3-year disease-free and overall survival of 41.9 and 66.1% in patients who underwent robotic liver surgery for CRLM, respectively. The overall and major morbidity in this study were 27 and 5%, respectively [5]. These data highlight the value of both minimally invasive techniques, i.e., robotics and laparoscopy in surgery for CRLM.…”

Section: Introductionsupporting

confidence: 64%

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Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

et al. 2020

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Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

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Section: Introductionsupporting

confidence: 64%

“…Our complication rates were comparable with the literature. Other studies report an overall complication rate of 19 to 29.6% after MILS [4,5,10,11,15,16]. The mortality rate for MILS is reported in the literature to range from 0 to 0.3% [4,5,15,16].…”

Section: Discussionmentioning

confidence: 95%

Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

et al. 2020

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“…Conversion tax ranged from 0% to 12%. Complications and major morbidity included delayed wound healing after an abdominal perineal resection (APR) and a delayed rectal anastomotic failure after ileostomy reversal in synchronous resection [11] , 1 postoperative bile leak, 2 heart failure [9] . 90 days mortality was 0%.…”

Section: Crlm and Rasmentioning

confidence: 99%

“…In these three papers included in the review, we have different attitude. In the more extensive series described by Guerra et al [9] , 59 patients underwent robotic CLMR, describing only 4 cases of synchronous colorectal resection (3 right colectomy and 1 left colectomy). No data are available on postoperative outcome colorectal resection.…”

Section: Synchronous Treatmentmentioning

confidence: 99%

Robotic synchronous treatment of colorectal cancer and liver metastasis: state of the art

Sammarco¹,

de’Angelis²,

Testini³

et al. 2019

MIS

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Aim:To analyze the series in literature of pure robotic surgery. Methods:A complete review of the literature was performed to identify papers with data concerning robotic synchronous treatment of colorectal liver metastases.Results: Three papers demonstrate the feasibility of this kind of synchronous treatment. Conclusion:Robotic synchronous treatment of primary tumor and colorectal liver metastasis is feasible and safe.

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“…In a study with a large patient cohort consisting of 1,152 open hepatectomies for colorectal metastasis, the overall and surgical morbidity were 24.6% and 3.1%, respectively 18 . The overall morbidity in robotic liver surgery can reach up to 27% 19 – 21 .…”

Section: Introductionmentioning

confidence: 99%

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

Rahimli

Perrakis

Schellerer

et al. 2020

Sci Rep

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Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS−FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS−FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS−FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS−FLF group (p = 0.114). One patient in the MILS−FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.

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Outcomes of robotic liver resections for colorectal liver metastases. A multi-institutional analysis of minimally invasive ultrasound-guided robotic surgery

Cited by 35 publications

References 29 publications

Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

Robotic synchronous treatment of colorectal cancer and liver metastasis: state of the art

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

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