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结直肠癌肝转移的机器人肝脏切除术的结局。微创超声引导机器人手术的多机构分析。

Outcomes of robotic liver resections for colorectal liver metastases. A multi-institutional analysis of minimally invasive ultrasound-guided robotic surgery.

作者信息

Guerra Francesco, Guadagni Simone, Pesi Benedetta, Furbetta Niccolò, Di Franco Gregorio, Palmeri Matteo, Annecchiarico Mario, Eugeni Emilio, Coratti Andrea, Patriti Alberto, Morelli Luca

机构信息

Division of General, Oncological and Vascular Surgery, Ospedali Riuniti Marche Nord Hospital, Pesaro, Italy.

Division of General Surgery, University Hospital of Pisa, Pisa, Italy.

出版信息

Surg Oncol. 2019 Mar;28:14-18. doi: 10.1016/j.suronc.2018.10.011. Epub 2018 Nov 1.

Abstract

BACKGROUND

Current evidence supporting robotics to perform minimally invasive liver resection is based on single center case series reporting surgical outcomes in heterogeneous groups of patients. On the contrary, relatively scarce data specifically focusing on secondary hepatic malignancies is available. The objective of this study is to assess short- and long-term outcomes following liver resection for colorectal liver metastasis on a multi-institutional series of patients.

METHODS

All consecutive patients undergoing robotic surgery for colorectal liver metastasis at three different tertiary hospitals over a 10-year time frame were included in this analysis. All patients received ultrasound-guided liver resection according to tumor location following the principle of parenchymal sparing surgery. Perioperative, clinicopathologic and oncological outcomes were assessed.

RESULTS

A total of 59 patients underwent liver resection. There were 7 cases of conversion to open surgery. The postoperative complication rate was 27%, 5% being the rate of major morbidity. Overall, the mean postoperative hospital stay was 6 days and no mortality occurred. R0 resection was achieved for 92% of lesions. At a mean follow-up of 19 months, the 1-year and 3-year DFS was 83.5% and 41.9%, while the 1-year and 3-year OS was 90.4% and 66.1%, respectively.

CONCLUSIONS

Robotic liver surgery does not impair surgical outcome and oncological results in patients with liver metastases from colorectal cancer.

摘要

背景

目前支持机器人进行微创肝切除术的证据基于单中心病例系列,报告了不同患者群体的手术结果。相反,专门针对继发性肝恶性肿瘤的数据相对较少。本研究的目的是评估多机构系列患者行肝切除治疗结直肠癌肝转移后的短期和长期结果。

方法

本分析纳入了在10年时间内于三家不同的三级医院接受机器人手术治疗结直肠癌肝转移的所有连续患者。所有患者均根据肿瘤位置,按照实质保留手术原则接受超声引导下肝切除术。评估围手术期、临床病理和肿瘤学结果。

结果

共有59例患者接受了肝切除术。有7例转为开放手术。术后并发症发生率为27%,严重并发症发生率为5%。总体而言,术后平均住院时间为6天,无死亡发生。92%的病灶实现了R0切除。平均随访19个月时,1年和3年无病生存率分别为83.5%和41.9%,1年和3年总生存率分别为90.4%和66.1%。

结论

机器人肝脏手术不会损害结直肠癌肝转移患者的手术结果和肿瘤学结果。

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