Robot-assisted procedure versus open surgery for simultaneous resection of colorectal cancer with liver metastases: Short-term outcomes of a randomized controlled study

Abstract

Background: Simultaneous resection of both colorectal cancer and liver metastases is a safe and effecttive surgical procedure for treating colorectal cancer patients with liver metastases (CRCLM). The safety and efficacy of robot‐assisted simultaneous resection of CRCLM is unclear. Furthermore, what kind of selective CRCLM patients would obtain benefits from robot‐assisted procedure need to identify. The aim of this study was designed to compare robot‐assisted procedure with open surgery, and establish robot‐assisted surgery indications to identify benefit population of CRCLM. Methods: CRCLM patients were evaluated and confirmed with surgical indication by multidisciplinary team (MDT), and randomized to two groups, robotic arm (n = 60) and open arm (n= 60). The primary endpoint is three years disease‐free survival, the second endpoints include short‐term surgical outcomes, complications and safety. Results: Sixty patients underwent robotic surgery and 60 patients accepted open surgery from September 2013 to June 2017. Only 1 patient in robotic arm converted to open surgery for drop of pressure induced by oppressing inferior vena cava during hep‐atectomy. Despite longer operating time in robotic arm versus open arm, patients assigned to robotic surgery had less blood loss (99.3 ml vs. 205.1 ml, P <0.001), shorter time to pass first flatus (63.0 hours vs. 93.6 hours, P <0.001), return to fluid diet (83.2 hours vs. 113.2 hours, P =0.002), and shorter hospital stay with improved urinary function. Furthermore, faster recovery of stress response and liver function were observed in robotic arm, and Dindo grade III/IV complication was decreased in robotic arm (6.7% vs20.0%, P=0.032). In addition, we identified and recommended CRCLM patients with number of liver metastases<3, maximal lesions size < 5cm to accept robot‐assisted surgery. Table: 143O Comparison between robot‐assisted and open surgery concerning postoperative outcomes Robotic Open ArmArm (n560) (n560) P First time to flatus (hours, Mean6SD) Return to fluid diet (hours, Mean6SD) Postoperative hospital stay (days, Mean6SD) CRP‐POD1 (mg/L, Mean6SD) CRP‐POD5 (mg/L, Mean6SD) ALT POD5 (U/mL, Mean6SD) AST POD5 (U/mL, Mean6SD) 63.0628.293.6635.5.000 83.2634.1113.6664.5.002 8.162.110.664.9.001 24.8628.747.0638.8.001 117.8645.3161.6633.8.000 68.66113.1139.76118.7.001 29.1619.745.5643.6.009 Conclusions: We identify and recommend selective CRCLM patients to accept robot‐assisted surgery for treating liver metastases. Robot‐assisted procedure results in similar safety as open surgery, with shorter recovery time, decreased complication rate, and improved urinary function.