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

Abstract

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.

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

“…Clavien-Dindo complications of grade 3 and above occurred in 4-6% of the laparoscopic patients, 0-22% in the robotic cohort and 25-35% in the open cohort and, although this difference was statistically significant only when the LLR was compared to the OLR group, these rates are well within the range published in the literature of 5-55% after laparoscopic hepatectomy, 17-20% after robotic resection and 17-61% after open hepatectomy [33,35,36]. The major cause of morbidity after major liver resection is bile leak with 13.5% of patients after major hepatectomy found to have a bile leak in one study [37].…”

Keeping surgeons in the loop: are handheld robotics the best path towards more autonomous actions? (A comparison of complete vs. handheld robotic hepatectomy for colorectal liver metastases)

“…When we compared cases done with HR vs. CR, similar to other studies, we found that cases done with the CR approach were statistically longer than after HR [Table 3], but estimated blood loss was not higher as in most studies [35] . It is unclear if more complex liver resections will one day be done by the CR approach as suggested by this German study [36] , but what is clear is that whatever approach a surgeon is most comfortable with is clearly better for outcomes in the short term [37] .…”

Robotic surgery for colorectal liver metastases resection: A systematic review

“…Comparing our data with data reported by referral centres for HPB surgery with a huge experience in laparoscopic liver surgery, so we can underline that through the robot assisted approach, general surgeons even if they are not dedicated to HPB may achieve perioperative outcomes superimposable to the standard of care. 25,27,28,30 4.9 | Costs None of the included studies reported cost data. One of the most popular drawbacks of robotic surgery is its cost-effectiveness, which is apparently more disadvantageous than conventional techniques.…”