USL Toscana Sud Est, Grosseto, Italy.
USL Toscana Sud Est, Grosseto, Italy.
Surg Oncol. 2022 Aug;43:101816. doi: 10.1016/j.suronc.2022.101816. Epub 2022 Jul 8.
How best to manage colorectal cancer patients presenting resectable synchronous liver metastasis is still a matter of debate. A number of different available therapeutic strategies exist, with significant differences in terms of optimal timing and/or sequence of resection of the primary tumor and liver disease [1]. Over the last years, simultaneous resections are increasingly adopted for properly selected patients [1-3]. However, the application of minimally invasive surgery to combined colorectal and liver surgery is still controversial, especially in the case of liver disease requiring technically demanding resections [2,3].
The presented video illustrates the details of a single-docking robotic right colectomy combined with ultrasound-guided, parenchymal-sparing resection of liver segments 6 and 7, as performed to treat a patient with locally advanced colorectal cancer and metastatic disease isolated to the right liver. Port placement strategy and main instrumentation employed are illustrated in Fig. 1, and Fig. 2, respectively. The total duration of surgery was 380 minutes. The hepatic hilum was encircled to allow extracorporeal Pringle maneuver during liver resection, though no clamping was eventually required. Right colectomy with central vascular ligation was thus carried out and an intracorporeal ileocolic anastomosis performed. The patient had an uneventful postoperative course.
When feasible, minimally invasive simultaneous resection may offer distinct advantages over conventional surgery while respecting the tenets of appropriate oncological resection [2,3]. The well-known benefits of minimally invasive surgery, including shorter overall hospital length of stay, reduced morbidity, and lower blood loss, are combined with the need to recover from a single major surgery. Robotic resection may be particularly suited for technically challenging procedures, such as colectomy combined with liver metastasectomies with unfavorable anatomical accessibility [3,4].
如何最好地管理呈现可切除同步肝转移的结直肠癌患者仍然存在争议。存在许多不同的治疗策略，在原发性肿瘤和肝脏疾病切除的最佳时机和/或顺序方面存在显著差异[1]。在过去几年中，越来越多的合适患者采用同时切除[1-3]。然而，微创技术在结直肠和肝脏联合手术中的应用仍然存在争议，尤其是在需要技术要求高的肝切除术的情况下[2,3]。
所呈现的视频说明了单停靠式机器人右结肠切除术与超声引导下肝段 6 和 7 节段保肝切除术相结合的细节，用于治疗局部晚期结直肠癌和转移性疾病孤立于右肝的患者。端口放置策略和主要仪器如图 1 和图 2 所示。手术总时长为 380 分钟。肝门被环绕，以便在肝切除期间进行体外普雷尔 maneuvers，但最终不需要夹闭。因此进行右结肠切除术伴中央血管结扎，并进行体内回肠结肠吻合术。患者术后无并发症。
在可行的情况下，微创同时切除可能比传统手术具有明显优势，同时尊重适当的肿瘤学切除原则[2,3]。微创外科的众所周知的优势，包括总体住院时间更短、发病率更低、出血量更少，与需要从单一主要手术中恢复相结合。机器人切除术可能特别适合技术上具有挑战性的手术，例如合并具有不利解剖可及性的肝转移切除术的结肠切除术[3,4]。
