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 Tsung2
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.
|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 (%)]|
|- Bile leak or intraabdominal collection||7|
|- Cardiac arrhythmia||5|
|- 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)|