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Oncological and surgical result of hepatoma after robot surgery

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Abstract

Background

Most liver resections are currently performed using an open approach. Robotic hepatectomy has been suggested as a safe and effective approach for hepatocellular carcinoma; however, studies regarding oncological and surgical outcomes are still limited. Accordingly, we performed this study to compare the surgical and oncological outcomes between robotic and open approaches.

Methods

Between June, 2013 and July, 2016, a total of 63 HCC patients undergoing robotic hepatectomy, and 177 patients undergoing open hepatectomy were included in this study to assess the surgical and oncological outcomes after hepatectomy. The data of demographic, clinical features, hepatitis profile, tumor characters, TNM stage, surgical type, pathological outcomes, and postoperative results were collected prospectively and analyzed retrospectively.

Results

The demographic and clinical features of patients with HCC in both groups were statistically comparable. The robotic group had longer operative times (296 ± 84 vs. 182 ± 51 min, p = 0.032). The postoperative complications rate was slightly lower in the robotic group (11.1 vs. 15.3%, p = 0.418). The rate of Ro resection was similar in both groups (93.7 vs. 96%, p = 0.56). The length of hospital stay was significantly shorter in the robotic group (6.21 ± 2.06 vs. 8.18 ± 6.99 days, p = 0.001). The overall recurrence rate of HCC was lower in the robotic group (27 vs. 37.3%, p = 0.140). The 1, 2, 3 year disease-free survival rates were 72.5, 64.3, and 61.6%, respectively, for the open group, while they were 77.8, 71.9, and 71.9%, respectively, for the robotic group, (p = 0.325). The 1, 2, 3 year overall survival rates were 95.4, 92.3, and 92.3%, respectively, for the open group, while they were 100, 97.7, and 97.7%, respectively, for the robotic group (p = 0.137).

Conclusion

Robotic surgery is a safe and feasible procedure for liver resection in selected patients. The oncological and surgical outcomes of robotic hepatectomy were comparable to open surgery. The robotic hepatectomy carried significantly shorter length of hospital stay.

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References

  1. Forner A. Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255

    Article  PubMed  Google Scholar 

  2. Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53: 1020–1022

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rahbari NN, Mehrabi A, Mollberg NM, Muller SA, Koch M, Buchler MW, Weitz J (2011) Hepatocellular carcinoma: current management and perspectives for the future. Ann Surg 253:453–469

    Article  PubMed  Google Scholar 

  4. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasbery S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement 2008. Ann Surg 250:825–830

    Article  PubMed  Google Scholar 

  5. Clinical Outcomes of Surgical Therapy Study G (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350: 2050–2059

    Article  Google Scholar 

  6. Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASPCC trial): multicentre, randomized controlled trial. Lancet 36:1718–1726

    Article  Google Scholar 

  7. Martek G, Boushey RP (2006) Laparoscopic colon surgery: past, present and future. Surg Clin North Am 86:867–897

    Article  Google Scholar 

  8. Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  9. Giulianotti PC, Coratti A, Angelini M et al (2003) Robotic in general surgery: Personal experience in a large community hospital. Arch Surg 138:777–784

    Article  PubMed  Google Scholar 

  10. Diana M, Marescaux J (2015) Robotic surgery. Br J Surg 102:e15–e28

    Article  PubMed  CAS  Google Scholar 

  11. Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC, Annechiarico M, Benedetti E (2011) Robotic liver surgery: results for 70 resections. Surgery 149:29–39

    Article  PubMed  Google Scholar 

  12. Bagante F, Spolverato G, Strasgerg SM, Gan Fi, Thompson V, Hall BL, Bentrem DJ, Pitt HA, Pawlik TM (2016) Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database. J Gastronintest Surg 20:1608–1617

    Article  Google Scholar 

  13. Tranchart H, Ceribelli C, Ferreti S, Dagher I, Patriti A (2014) Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg 38:29.4–29.9

    Article  Google Scholar 

  14. Croner RS, Perrakis A, Hohenberger W, Brunner M (2016) Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg 401:707–714

    Article  PubMed  Google Scholar 

  15. Qiu J, Chen S, Chengyou D (2016) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30:862–875

    Article  PubMed  Google Scholar 

  16. Bonapasta SA, Bartomini I, Checcacci P, Guerra F, Coratti A (2015) Indications for liver surgery: laparoscopic or robotic approach. Surg 67:117–122

    Google Scholar 

  17. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2804 patients. Ann Surg 250:831–884

    Article  PubMed  Google Scholar 

  18. Lai EC, Tang CN (2016) Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Tech 26:162–166

    Article  PubMed  Google Scholar 

  19. Ocuin LM, Tsung A (2015) Robotic liver resection for malignancy: current status, oncologic outcomes, comparison to laparoscopy and future applications. J Surg Oncol 112:295–301

    Article  PubMed  Google Scholar 

  20. Ho CM, Wakanayahi G, Nitta H, Itl N, Hasegawa Y, Takahara T (2013) Systematic review of robotic liver resection. Surg Endosc 27:732–739

    Article  PubMed  Google Scholar 

  21. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355

    Article  PubMed  Google Scholar 

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  23. Morel P, Jung M, Cornateanu S, Buehler L, Majno P, Toso C, Buchs NC, Rubbia-Brandt L, Hagen ME (2017) Robotic versus open liver resections: a case-matched comparison. Int J Med Robot. https://doi.org/10.1002/rcs.1800 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  24. Sham JG, Richards MK, Seo YD, Pillariaetty VG, Yeung RS, Park JO (2016) Efficacy and cost of robotic hepatectomy: is the robotic cost-prohibitive? J Robotic Surg 10:307–313

    Article  Google Scholar 

  25. Chen PD, Wu CY, Hu RH, Chou WH, Lai HS, Liang JH, Lee PO, Wu YM (2017) Robotic versus open hepatectomy for hepatocellular carcinoma: a matched comparison. Ann Surg Oncol 24:1021–1028

    Article  PubMed  Google Scholar 

  26. Anvari M, Birch DW, Bamehriz F, Gryfe R, Chapman T (2004) Robotic-assisted laparoscopic colorectal surgery. Surg Laparosc Endosc Percutan Tech 14:311–315

    Article  PubMed  Google Scholar 

  27. Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188:19S–26S

    Article  PubMed  Google Scholar 

  28. Kingham TP, Leung U, Kuk D, Gonen M, D’Angelica M, Allen P, DeMatteo R, Laudone VP, Jarnagin WR, Fong Y (2016) Robotic liver resection: a case-matched comparison. World J Surg 40:1422–1428

    Article  PubMed  PubMed Central  Google Scholar 

  29. Patriti A, Cipriani F, Ratti F, Bartoli A, Ceccarelli G, Casciola L, Aldrighetti L (2014) Robotic-assisted versus open liver resection in the right posterior section. JSLS 18:1–6

    Article  Google Scholar 

  30. Daskalaki D, Gonzalez-Heredia R, Brown M, Bianco FM, Tzvetanov I, Davis M, Kim J, Benedetti E, Giulianotti PC (2017) Financial impact of the robotic approach in liver surgery: a comparative study of clinical outcomes and costs between the robotic and open technique in a single institution. J Laparoendosc Adv Surg Tech 27:375–382

    Article  Google Scholar 

  31. Lai E, Yang GC, Tang CN (2013) Robotic-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205:697–702

    Article  PubMed  Google Scholar 

  32. Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, Marsh W, Reddy SK, Bartlett DL (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555

    Article  PubMed  Google Scholar 

  33. Han DH, Choi SH, Park EJ, Kang DR, choi GH, Choi JS (2016) Surgical outcomes after laparoscopic or robotic liver resection in hepatocellular carcinoma: a propensity-score matched analysis with conventional open liver resection. Int J Med Robot 12:735–742

    Article  PubMed  Google Scholar 

  34. Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robotic-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824

    Article  PubMed  Google Scholar 

  35. Roberto Montaliti R, Scuderi V, Patriti A, Vivarelli M (2016) Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30:1004–1013

    Article  Google Scholar 

  36. Troisi R, Patriti A, Montalti R, Casciola L (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot 9:160–166

    Article  PubMed  Google Scholar 

  37. Nota CL, Borel IH, Molenaar IQ, van Santvoort HC, Fong Y, Hagendoom J (2016) Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomy. HBP 18:113–120

    Google Scholar 

  38. Lee KT, Wang SN, Chen HY, Shi HY, Ker CG, Chiu HC (2012) Is wider surgical margin justified for better clinical outcomes in patients with resectable hepatocellular carcinoma? J Formos Med Assoc 111:160–170

    Article  PubMed  Google Scholar 

  39. Matsui Y, Terakawa N, Satoi S, Kaibori M, Kitade H, Takai S, Kwon AH, Kamiyama Y (2007) Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface. Arch Surg 142:596–602

    Article  PubMed  Google Scholar 

  40. Dahiya D, Wu TJ, Lee CF, Chan KM, Lee WC, Chen MF (2010) Minor versus major hepatic resection for small hepatocellular carcinoma (HCC) in cirrhotic patients: a 20-year experience. Surgery 147:676–685

    Article  PubMed  Google Scholar 

  41. Torzilli G, Montorsi M, Donadon M, Palmisano A, Fabbro DD, Gambetti A, Olivari N, Makunchi M (2005) “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201:517–528

    Article  PubMed  Google Scholar 

  42. Torzilli G, Montorsi M, Del Fabbro A, Palmisano M, Donadon, Makunchi M (2006) Ultrasonographically guided surgical approach to liver tumors involving the hepatic veins close to the caval confluence. Br J Surg 93:1238–1246

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan

    Wen-Hsiuan Wang

  2. Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzy-you 1st Rd, Kaohsiung, 807, Taiwan

    Kung-Kai Kuo, Shen-Nien Wang & King-Teh Lee

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Correspondence to King-Teh Lee.

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Authors Wen-Hsiuan Wang, Kung-Kai Kuo, Shen-Nien Wang, King-Teh Lee have no conflicts of interest or financial ties to disclose.

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Wang, WH., Kuo, KK., Wang, SN. et al. Oncological and surgical result of hepatoma after robot surgery. Surg Endosc 32, 3918–3924 (2018). https://doi.org/10.1007/s00464-018-6131-2

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