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Robotic simultaneous resection for colorectal liver metastasis: feasibility for all types of liver resection

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Abstract

Background

A laparoscopic approach is increasingly being utilized in simultaneous colorectal and liver resection (SCLR) for colorectal cancer with liver metastasis. However, this approach is technically challenging and hence has not been widely adopted. Robotic surgical systems could potentially overcome this problem. We aim to describe the feasibility and outcomes of robotic SCLR for colorectal carcinoma with liver metastasis.

Methods

The medical records of 12 patients who underwent robotic SCLR for colorectal cancer with liver metastasis between January 2008 and September 2018 were reviewed retrospectively.

Results

The mean age was 59 years (range, 37–77 years). The liver resections were comprised of two right hepatectomies, one left hepatectomy, one left lateral sectionectomy, one segmentectomy of S3 and wedge resection (segment 7), one caudate lobectomy, one associated liver partition and portal vein ligation for staged hepatectomy, and five wedge resections involving segments 4, 5, 6, 7, or 8. The colorectal procedures involved seven low-anterior resections, two anterior resections, two right hemicolectomies, and one left hemicolectomy. The mean operative time was 449 min (range, 135–682 min) with a mean estimated blood loss of 274.3 mL (range, 40–780 mL). The mean length of hospital stay was 12 days (range, 5–28 days). No patients required conversion to laparotomy. Liver resection–related complications were two liver abscesses (Clavien-Dindo classification, one grade II and one grade III) and one case of ascites (grade I), whereas colorectal resection-related complications included one anastomosis leak (grade III) and one superficial wound infection (grade II). There were no deaths reported within 30 days of the procedure. With a mean follow-up duration of 31.5 ± 26.1 months, the overall survival and disease-free survival values were 75.2 and 47.1 months, respectively.

Conclusion

Robotic SCLR for colorectal neoplasm with liver metastasis can be performed safely even in cases requiring major liver resections, especially in a specialized center with a well-trained team.

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References

  1. Slesser AAP, Chand M, Goldin R, Brown G, Tekkis PP, Mudan S (2013) Outcomes of simultaneous resections for patients with synchronous colorectal liver metastases. Eur J Surg Oncol 39:1384–1393

    Article  CAS  PubMed  Google Scholar 

  2. Reddy SK, Pawlik TM, Zorzi D, Gleisner AL, Ribero D, Assumpcao L, Barbas AS, Abdalla EK, Choti MA, Vauthey J-N, Ludwig KA, Mantyh CR, Morse MA, Clary BM (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14:3481–3491

    Article  PubMed  Google Scholar 

  3. Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, Jarnagin W, Blumgart L (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241

    Article  PubMed  Google Scholar 

  4. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–407

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gorgun E, Yazici P, Onder A, Benlice C, Yigitbas H, Kahramangil B, Tasci Y, Aksoy E, Aucejo F, Quintini C, Miller C, Berber E (2017) Laparoscopic versus open 1-stage resection of synchronous liver metastases and primary colorectal cancer. Gland Surg 6:324–329

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kim SH, Lim SB, Ha YH, Han SS, Park SJ, Choi HS, Jeong SY (2008) Laparoscopic-assisted combined colon and liver resection for primary colorectal cancer with synchronous liver metastases: initial experience. World J Surg 32:2701–2706

    Article  PubMed  Google Scholar 

  7. Miyamoto Y, Beppu T, Sakamoto Y, Imai K, Hayashi H, Nitta H, Ishiko T, Watanabe M, Baba H (2015) Simultaneous laparoscopic resection of primary tumor and liver metastases for colorectal cancer: surgical technique and short-term outcome. Hepatogastroenterology 62:846–852

    PubMed  Google Scholar 

  8. Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S (2019) Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc 33:1482–1490

    Article  PubMed  Google Scholar 

  9. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22:1601–1608

    Article  CAS  PubMed  Google Scholar 

  10. Feroci F, Vannucchi A, Bianchi PP, Cantafio S, Garzi A, Formisano G, Scatizzi M (2016) Total mesorectal excision for mid and low rectal cancer: laparoscopic vs robotic surgery. World J Gastroenterol 22:3602–3610

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. Jama 318:1569–1580

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim MJ, Park SC, Park JW, Chang HJ, Kim DY, Nam BH, Sohn DK, Oh JH (2018) Robot-assisted versus laparoscopic surgery for rectal cancer: a phase II open label prospective randomized controlled trial. Ann Surg 267:243–251

    Article  PubMed  Google Scholar 

  13. van Dalen A, Ali UA, Murray ACA, Kiran RP (2019) Optimizing patient selection for laparoscopic and open colorectal cancer resections: a national surgical quality improvement program-matched analysis. Am Surg 85:206–213

    Article  PubMed  Google Scholar 

  14. Troisi RI, Patriti A, Montalti R, Casciola L (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot 9:160–166

    Article  PubMed  Google Scholar 

  15. Qiu J, Chen S, Chengyou D (2016) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30:862–875

    Article  PubMed  Google Scholar 

  16. Dwyer RH, Scheidt MJ, Marshall JS, Tsoraides SS (2018) Safety and efficacy of synchronous robotic surgery for colorectal cancer with liver metastases. J Robot Surg 12:603–606

    Article  PubMed  Google Scholar 

  17. Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L (2009) Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepato-Biliary-Pancreat Surg 16:450–457

    Article  Google Scholar 

  18. Bae SU, Baek SJ, Hur H, Baik SH, Kim NK, Min BS (2015) Robotic left colon cancer resection: a dual docking technique that maximizes splenic flexure mobilization. Surg Endosc 29:1303–1309

    Article  PubMed  Google Scholar 

  19. Bae SU, Yang SY, Min BS (2018) Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes. Int J Color Dis 34:471–479

    Article  Google Scholar 

  20. Choi GH, Choi SH, Kim SH, Hwang HK, Kang CM, Choi JS, Lee WJ (2012) Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc 26:2247–2258

    Article  PubMed  Google Scholar 

  21. Choi SH, Choi GH, Han DH, Choi JS (2015) Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases. Surg Endosc 29:387–397

    Article  PubMed  Google Scholar 

  22. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR, van Laarhoven CJ (2016) Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev 4:Cd011391

    PubMed  Google Scholar 

  23. Rutledge R, Fakhry SM, Baker CC, Meyer AA (1996) The impact of laparoscopic cholecystectomy on the management and outcome of biliary tract disease in North Carolina: a statewide, population-based, time-series analysis. J Am Coll Surg 183:31–45

    CAS  PubMed  Google Scholar 

  24. Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, Christie NA, Weksler B, Landreneau RJ, Abbas G, Schuchert MJ, Nason KS (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256:95–103

    Article  PubMed  Google Scholar 

  25. Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–767

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tønnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Røsok BI, Bjørnbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207

    Article  PubMed  Google Scholar 

  27. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  28. Corrigan N, Marshall H, Croft J, Copeland J, Jayne D, Brown J (2018) Exploring and adjusting for potential learning effects in ROLARR: a randomised controlled trial comparing robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection. Trials 19:339

    Article  PubMed  PubMed Central  Google Scholar 

  29. Panteleimonitis S, Popeskou S, Aradaib M, Harper M, Ahmed J, Ahmad M, Qureshi T, Figueiredo N, Parvaiz A (2018) Implementation of robotic rectal surgery training programme: importance of standardisation and structured training. Langenbeck's Arch Surg 403:749–760

    Article  Google Scholar 

  30. Knab LM, Zureikat AH, Zeh HJ 3rd, Hogg ME (2017) Towards standardized robotic surgery in gastrointestinal oncology. Langenbeck's Arch Surg 402:1003–1014

    Article  Google Scholar 

  31. Choi SB, Park JS, Kim JK, Hyung WJ, Kim KS, Yoon DS, Lee WJ, Kim BR (2008) Early experiences of robotic-assisted laparoscopic liver resection. Yonsei Med J 49:632–638

    Article  PubMed  PubMed Central  Google Scholar 

  32. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H (2009) Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 16:1480–1487

    Article  PubMed  Google Scholar 

  33. **ong B, Ma L, Huang W, Zhao Q, Cheng Y, Liu J (2015) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19:516–526

    Article  PubMed  Google Scholar 

  34. Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H, Ma Y (2012) Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol 19:3727–3736

    Article  PubMed  Google Scholar 

  35. Xu J-M, Wei Y, Wang X-Y, Fan H, Chang W-J, Ren L, Jiang W, Fan J, Qin X-Y (2015) Robot-assisted one-stage resection of rectal cancer with liver and lung metastases. World J Gastroenterol 21:2848–2853

    Article  PubMed  PubMed Central  Google Scholar 

  36. Baek SJ, Kim SH, Cho JS, Shin JW, Kim J (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36:2722–2729

    Article  PubMed  Google Scholar 

  37. Guerra F, Amore Bonapasta S, Annecchiarico M, Bongiolatti S, Coratti A (2015) Robot-integrated intraoperative ultrasound: Initial experience with hepatic malignancies. Minim Invasive Ther Allied Technol 24:345–349

    Article  PubMed  Google Scholar 

  38. Takahashi H, Zaidi N, Berber E (2016) An initial report on the intraoperative use of indocyanine green fluorescence imaging in the surgical management of liver tumorss. J Surg Oncol 114:625–629

    Article  PubMed  Google Scholar 

  39. Liberale G, Bourgeois P, Larsimont D, Moreau M, Donckier V, Ishizawa T (2017) Indocyanine green fluorescence-guided surgery after IV injection in metastatic colorectal cancer: a systematic review. Eur J Surg Oncol 43:1656–1667

    Article  CAS  PubMed  Google Scholar 

  40. van der Vorst JR, Schaafsma BE, Hutteman M, Verbeek FP, Liefers GJ, Hartgrink HH, Smit VT, Lowik CW, van de Velde CJ, Frangioni JV, Vahrmeijer AL (2013) Near-infrared fluorescence-guided resection of colorectal liver metastases. Cancer 119:3411–3418

    Article  PubMed  CAS  Google Scholar 

  41. Shockcor NM, Sultan S, Alvarez-Casas J, Brazio PS, Phelan M, LaMattina JC, Barth RN (2018) Minimally invasive donor nephrectomy: current state of the art. Langenbeck’s Arch Surg 403:681–691

    Article  Google Scholar 

  42. Cuendis-Velazquez A, Bada-Yllan O, Trejo-Avila M, Rosales-Castaneda E, Rodriguez-Parra A, Moreno-Ordaz A, Cardenas-Lailson E, Rojano-Rodriguez M, Sanjuan-Martinez C, Moreno-Portillo M (2018) Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury. Langenbeck's Arch Surg 403:53–59

    Article  Google Scholar 

  43. Huttenbrink C, Hatiboglu G, Simpfendorfer T, Radtke JP, Becker R, Teber D, Hadaschik B, Pahernik S, Hohenfellner M (2018) Incidental appendectomy during robotic laparoscopic prostatectomy-safe and worth to perform? Langenbeck's Arch Surg 403:265–269

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, #50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Jonathan Navarro, Seoung Yoon Rho, Incheon Kang, Gi Hong Choi & Byung Soh Min

  2. Department of Surgery, Vicente Sotto MemorialMedical Center, B. Rodriguez street, Cebu City, 6000, Philippines

    Jonathan Navarro

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  4. Gi Hong Choi
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Contributions

Study conception and design: Jonathan Navarro, Gi Hong Choi, Byung Soh Min. Acquisition of data: Jonathan Navarro, Seoung Yoon Rho, Incheon Kang, Gi Hong Choi, Byung Soh Min. Analysis and interpretation of data: Jonathan Navarro, Gi Hong Choi. Drafting of manuscript: Jonathan Navarro. Critical revision of manuscript: Jonathan Navarro, Seoung Yoon Rho, Incheon Kang, Gi Hong Choi, Byung Soh Min.

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Correspondence to Gi Hong Choi.

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Navarro, J., Rho, S.Y., Kang, I. et al. Robotic simultaneous resection for colorectal liver metastasis: feasibility for all types of liver resection. Langenbecks Arch Surg 404, 895–908 (2019). https://doi.org/10.1007/s00423-019-01833-7

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