2nd Department of Propaedeutic Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Ag. Thoma 17, 11527, Athens, Greece.
1st Department of Surgery, Nationals and Kapodistrian University of Athens, General Hospital Laiko, Athens, Greece.
J Robot Surg. 2021 Dec;15(6):841-848. doi: 10.1007/s11701-021-01213-8. Epub 2021 Feb 17.
Simultaneous resections of primary colorectal cancer (CRC) and synchronous colorectal liver metastases (CRLM) have emerged as safe and efficient procedures for selected patients. Besides the traditional open approach for simultaneous resections, similar outcomes have been reported for minimally invasive approaches. Over the past years, a number of studies have sought to evaluate the safety and efficacy of simultaneous robotic-assisted resections (SRAR) for patients with synchronous CRC and CRLM. The objective of this systematic review is to evaluate the safety, technical feasibility and outcomes of SRAR of the primary CRC and CRLM. A comprehensive review of the literature was undertaken. Nine studies comprising a total of 29 patients (16 males) who underwent SRAR were considered eligible for inclusion. The primary tumor site was the rectum in 22 (76%) patients and the colon in 7 (24%) patients. A minor liver resection was performed in the majority of the cases (n = 24; 82%). The median operative time and estimated blood loss were 399.5 min (range 300-682) and 274 ml (range 10-780 ml), respectively. No cases of conversion to open were reported. The median LOS was 7 days (range 2-28 days). All patients reportedly underwent R0 resection. Overall and major morbidity rates were 38% and 7%, respectively, while no perioperative deaths were reported. Despite the limited number of studies, SRAR seems to be a safe and efficient minimally invasive approach for highly selected patients always implemented in the context of multidisciplinary patient management.
同时切除原发结直肠癌(CRC)和同时性结直肠肝转移(CRLM)已成为某些患者安全有效的治疗方法。除了传统的开腹手术外,微创方法也取得了类似的效果。近年来,许多研究都试图评估机器人辅助同时结直肠癌和 CRLM 切除术(SRAR)对患者的安全性和疗效。本系统评价的目的是评估同时切除原发 CRC 和 CRLM 时 SRAR 的安全性、技术可行性和结果。对文献进行了全面回顾。共纳入 9 项研究,总计 29 例(男 16 例)患者符合纳入标准。22 例(76%)患者的原发病灶位于直肠,7 例(24%)患者位于结肠。大多数病例都进行了较小的肝切除术(n=24;82%)。手术时间中位数为 399.5 分钟(范围 300-682 分钟),估计出血量中位数为 274ml(范围 10-780ml)。无中转开腹的病例报告。中位住院时间为 7 天(范围 2-28 天)。所有患者均报告行 R0 切除。总的和主要发病率分别为 38%和 7%,无围手术期死亡。尽管研究数量有限,但 SRAR 似乎是一种安全有效的微创方法,适用于高度选择的患者,始终在多学科患者管理的背景下实施。