A Single Institution Experience of Colorectal Liver Metastasis Treatment with the da Vinci Robotic System

Aim: In the treatment of colorectal metastasis (CRLM), minimally invasive surgery (MIS) has gained increasing importance. However the widespread of standard laparoscopy for this indication is still limited, due to the drawbacks of the ultrasound (US) laparoscopic probe in performing a complete study of the liver (frequent multiple localizations), the synchronous presence of primary tumor to be resected or presence of previous surgery. The role of robot-assisted surgery (RAS) in this setting has not been evaluated in literature yet. The aim of this study, is to report our experience with RAS for treatment of CRLM. Methods: We retrospectively analyzed surgical and oncological data of all the robot-assisted liver resections for CRLM performed at our center from a prospectively-collected Institutional database. All the resections were performed with the da Vinci platform (Si since 2012, and Xi since 2015 for multiple organs resections). Intra-operative US scan was obtained with a dedicated robotic probe using the TilePro™ function. Result: Sixteen patients underwent robot-assisted resection of CRLM, between May 2012 and July 2017. Four patients (25%) had multiple synchronous CRLM resections (median = 2; range 2 – 3). The tumor size averaged 3.1±1.6 cm. All the lesions were removed following a parenchymal sparing approach, with R0 resection margins. In two cases, with the aid of da Vinci Xi, a synchronous colon resection was performed, whereas in the remaining cases the primary cancer had already been removed (8/14, 57%, with MIS and 6/14, 43%, with traditional approach). Mean hospital stay was 4.5±1.4 days. The mean follow up was 27.3±19 months and there were no local recurrences; while 7 patients (43%) developed new systemic metastasis. All patients are still alive with a 1 and 3 years disease-free survival of 77.5% and 36.3% respectively. Conclusions: In our experience, RAS for the surgical treatment of CRLM surgical treatment was feasible, and seemed to be oncologically safe as no patients experienced local relapse in the treated area. In this setting a dedicated US robotic probe and the availbility of Da Vinci Xi could improve the MIS approach especially in multiple localization and previous or synchronous surgery.