Steven S Tsoraides, MD, Rozana H Asfour, MD, Matthew J Scheidt, MD, J Stephen Marshall, MD. University of Illinois at Peoria
Timing of resection & treatment of colorectal cancer (CRC) with liver metastases varies based on patient characteristics & center protocols. Concerns of increased morbidity & mortality (M&M) related to anesthetic time & blood loss have limited widespread adaptation of synchronous colorectal & liver resections. Furthermore, technical challenges have made minimally invasive synchronous resections less common. We present the first reported series of synchronous robotic surgery for CRC with liver metastases.
Methods & Procedures
Retrospective review of prospectively collected data of patients with stage IV CRC with liver metastases treated at a tertiary center from February 2013 to June 2014. Patients who underwent synchronous robotic surgery for CRC with liver metastasis(es) were included & selected by a multidisciplinary cancer committee. Data included patient demographics, disease stage, OR time, EBL, & complications. All resections were performed robotically by the same well-experienced surgeons. A radiologist was present for intraoperative ultrasound. Liver treatment was performed first in consideration of intraoperative bleeding risk.
Sixty-six patients with Stage IV CRC were seen at the tertiary center during the study period. Six patients met inclusion criteria (2 male, 4 female). Mean age was 59.3 years & mean BMI was 23.46. Mean of 2 liver segments were involved. Four patients underwent metastatectomy; three with concurrent microwave ablation. One patient had ablation without resection & another had no identifiable lesion on ultrasound. The colonic resections included 3 low anterior resection, 2 abdominal perineal resections (APR), & 1 right hemicolectomy. Mean operative time was 401 mins (349-506 mins) with mean EBL of 316 mL (150-1000 mL). No conversions to an open approach occurred. Median length of stay (LOS) was 4.5 days (3-10 days). Complications included delayed wound healing after an APR & a rectal anastomotic failure after ileostomy reversal. There was no 30-day mortality. At a mean follow up of 19 months, one death occurred at 26 months & the remaining patients had documented metastatic disease.
Synchronous resection for metastatic CRC carries risks. We report the first series of synchronous robotic surgery for CRC with liver metastases. The robotic approach contributed to low blood loss, appropriate LOS, & no 30-day mortality. Morbidity experienced was consistent with the procedures & not related to the robotic technique. This series supports the potential benefits of synchronous resection from a technical standpoint. Further data is required to determine treatment & survival benefits. Limitations include small number & retrospective review of data.