SINGLE CENTRE EXPERIENCE OF ROBOT-ASSISTED SURGERY FOR COLORECTAL LIVER METASTASES

Objectives Minimally invasive surgery of the liver is increasingly spreading, but its role in the treatment of colorectal liver metastases (CRLM) still remains controversial. The most frequently reported limits in terms of feasibility and oncological safety of minimally invasive surgery for CRLM are multiple localization, limitations of the intra-operative laparoscopic probes in performing a complete study of the liver, synchronous presence of primary tumor to be resected or previous abdominal surgery. In this setting, the role of robot-assisted surgery (RAS) has not been evaluated in literature yet. The aim of this study is to report our experience with RAS for treatment of CRLM. Materials and methods Surgical and oncological outcomes of robot-assisted liver resections for CRLM performed at our centre between May 2012 and July 2017 were retrieved from a prospectively-collected Institutional database, and retrospectively analyzed. All the procedures were performed using the da Vinci platform (Si version since 2012, and Xi version since 2015 for multiple organs resections). The liver resection was performed using bipolar Maryland forceps or Gyrus PK SuperPulse Generator in the left hand and monopolar scissors in the right one. Intra-operative US scan was obtained with a dedicated robotic probe using the TilePro™ function. Results Sixteen patients underwent robot-assisted resection of CRLM in the study period. Four patients (25%) underwent 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 a synchronous colon resection was performed using the Xi platform, whereas in the remaining cases the primary cancer had already been removed (8/14 - 57% with minimally invasive technique and 6/14 - 43% with laparotomica approach). No conversions to open surgery and no intraoperative complications were observed. Mean hospital stay was 4.5  1.4 days. Mean follow up was 27.3 ± 19 months. During the study period no local recurrences were found, while 7 patients (43%) developed new systemic metastases. All patients were still alive at the end of the study period, with a 1 and 3 years disease-free survival of 77.5% and 36.3% respectively. Conclusions In our experience, RAS for CRLM surgical treatment resulted to be feasible even in patients with multiple localizations and previous or synchronous abdominal surgery. The availability of a dedicated US scan intra-operative probe directly controlled by the dominant hand of the operating surgeon similarly to the open approach, could improve the management of multiple localizations. The da Vinci Xi platform could improve the ability to perform a multi-quadrant surgery, particularly useful in presence of synchronous primary tumor to be resected. RAS seems to be oncologically safe in this setting, as no patients experienced local recurrence in the treated area.