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

Mirhasan Rahimli,Jörg Arend,Andrew Gumbs,Eric Lorenz,Aristotelis Perrakis,Vera Schellerer,Victor-Radu Negrini,Roland Siegfried Croner,Mareike Franz

doi:10.1186/s12957-020-02113-1

Abstract

BackgroundMinimally 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).MethodsTwenty-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.ResultsOperating 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.ConclusionMinimally 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.

Highlights

Invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence
The first group consisted of 13 patients, who underwent laparoscopic liver surgery (LLS), and the second group consisted of 12 patients, who underwent robotic liver surgery (RLS)
While the distribution of the sexes was equal in the robotic group, in the laparoscopic group the men predominated with 10 patients (76.9%)

Summary

Introduction

Invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. Liver metastases can be diagnosed in about 40% of patients with colorectal cancer. 20% of patients are diagnosed with synchronous liver metastases at the time of the initial diagnosis [1]. This is not a contraindication to surgery, because modern surgery combined with chemotherapy can achieve a 5-year survival rate up to 60% [2]. The use of minimally invasive liver surgery (MILS) is increasing worldwide. Currently there is still not enough evidence to determine its value in the treatment of colorectal liver metastases (CRLM). CRLM are increasingly being removed via minimally invasive approaches because of the potential benefit to patients [2,3,4]

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