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Robotic-assisted Liver Resection for Metastatic Colorectal Cancer: A Multicenter Evaluation of Long-term and Oncologic Outcomes
*Rachel E. Beard¹, Sidrah Khan², *Yuman Fong³, *T. Peter Kingham⁴, *Thomas Boerner⁴, *Eren Berber⁵, *Bora Kahramangil⁵, *John B. Martinie⁶, *Dionisios Vrochides⁶, *Aude Vanlander⁷, *Roberto I. Troisi⁷, *Joseph F. Buell⁸, *Michele Molinari², *Allan Tsung^2
1Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI; ²University of Pittsburgh Medical Center, Pittsburgh, PA; ³City of Hope National Medical Center, Duarte, CA; ⁴Memorial Sloan-Kettering, New York, NY; ⁵Cleveland Clinic, Cleveland, OH; ⁶Carolinas Medical Center, Charlotte, NC; ⁷Ghent University Hospital Medical School, Ghent, Belgium; ⁸Tulane University, New Orleans, LA

Objective: To assess long-term oncologic outcomes for robotic-assisted liver resection for colorectal cancer (CRC) metastases.
Setting: Although safety and short-term outcomes of robotic-assisted liver resection have been described, long-term and oncologic data are lacking.
Design: A retrospective study of all patients who underwent robotic-assisted liver resection for CRC metastases at six high volume centers in the United States and Europe between 2008 and 2016. The data were analyzed with a focus on oncologic outcomes and long-term recurrence and survival.
Results: Robotic-assisted liver resection for metastatic CRC was performed in 115 patients. The most common sites of the CRC primary were rectum (36.5%) and sigmoid (20%), and synchronous liver metastases were present in 42.6% of cases. Both minor (85.3%) and major resections (14.7%) were performed. Other concomitant procedures were performed in 62.6% of cases and six cases (5.2%) were converted to an open operation. R0 resection rate was 73.9% with the median closest margin being 0.6 cm (range 0.1 - 5.0 cm). Complication rates were 34% overall and 8.7% serious with one 30-day mortality. Recurrence occurred in 52.2% of patients. Overall survival was 97.3%, 71.3% and 54.5% and disease-specific survival was 61.6%, 37.1% and 28.5% at 1-, 3- and 5-years, respectively.
Conclusions: Robotic-assisted liver resection for colorectal metastases is feasible and safe, with long-term oncologic outcomes largely comparable to those reported in contemporaneous laparoscopic series.
Postoperative Outcomes

Perioperative death within 30 days [n (%)]	1 (0.9)
Complications [n (%)]	39 (34.0)
Serious complication (Clavien-Dindo ≥3) [n (%)]	10 (8.7)
Clavien-Dindo classification of complications [n]
- Grade 1	12
- Grade 2	17
- Grade 3	7
- Grade 4	2
- Grade 5	1
Type of complication [n (%)]
- Other*	21
- Bile leak or intraabdominal collection	7
- Cardiac arrhythmia	5
- Ileus	4
- Wound infection	2
Patients requiring reoperation within 30 days [n (%)]	1 (0.9)
Patients requiring readmission within 30 days [n (%)]	8 (7.0)
Intensive care unit admission [n (%)]	17 (14.8)
Length of stay in days [median (range)]	5 (1 – 15)

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