Robotic procedure versus open surgery for simultaneous resection of colorectal cancer with liver metastases: Short-term outcomes of a randomized controlled study.

Abstract

3575 Background: The simultaneous resecting both colorectal cancer and liver metastases is a safety and efficacy surgical procedure for treating colorectal cancer patients with liver metastases (CRCLM).The safety and efficacy of robot-assisted simultaneous resection of CRCLM is unclear. Furthermore, what kind of selective CRCLM patients would obtain benefits from robotic procedure need identify. The aim of this study was designed to compare robotic procedure with open surgery, and establish robotic surgery indications to identify benefit population of CRCLM. Methods: CRCLM patients were evaluated and confirmed with surgical indication by multidisciplinary team (MDT), and randomized to two groups, robotic arm (n = 58) and open arm (n = 57). The primary endpoint is 3-year DFS, the second endpoints include short-term surgical outcomes, complications and safety. Results: A total of 115 patients were randomized between September 2013 and September 2016. Despite longer operating time, patients assigned to robot-assisted surgery had less blood loss (100ml vs. 150ml, P < 0.001), a shorter time to pass first flatus (3 d vs. 4 d, P < 0.001) and return to diet (3 d vs. 5 d, P = 0.002), shorter hospital stay with improved sexual function. Furthermore, followed benefits were observed in robotic arm versus open arm: lower serum C reactive protein (CRP) level on postoperative day 1 (POD1) (16 mg/L vs. 37 mg/L,P < 0.001), and POD3 (112 mg/L vs. 160 mg/L, P < 0.001), lower level of liver transaminase on POD5, and lower liver-related complication morbidity(10.3% vs 28.1%, p = 0.016). In addition, we identified and recommended selective CRCLM patients with the number of liver metastases < 3, maximal tumor size < 5cm, tumor not located in segment I to accept robotic procedure. Conclusions: We identified and recommended selective CRCLM patients to accept robotic surgery for treating liver metastases. Robotic surgery result in similar safety as open procedure, with shorter recovery time, decreased morbidity, and improved sexual function. Clinical trial information: NCT02642978.

Mérföldkövek a máj sebészetében

“…A robotmájsebészet elsajátítása tapasztalt májsebész rendszeres, intenzív gyakorlását igényli: 15 beavatkozásig kezdő, 25 elvégeztével középszintű, 50 felett pedig begyakorlott robotvezérlő májsebészről beszélhetünk [41]. A colorectalis rák és egyidejű májmetasztázisa robot-vastagbélsebész/robotmájsebész munkacsoport együttműködésével hasonló biztonsággal távolítható el, mint nyílt beavatkozással, és a felépülési idő is rövidebb [42]. A laparoszkópos májsebészet kényes területe a "hátsó-felső" szegmentumok (VII-es, VIII-as, IVa és az 1-es szegmentum) minimálisan invazív reszekciója, amely újabban a robotsebészet célkeresztjében is megjelent, méghozzá hasonló kivitelezhetőséggel és biztonsággal [43].…”