Early and Long-term Outcomes of Laparoscopic and Robot-assisted Liver Resections. Specialized Center’s Experience

Aim. To compare early and long-term outcomes of laparoscopic and robot-assisted liver resections with open procedures.

Material and Methods. Retrospective case-control study was performed. Pseudo-randomization was used to compare homogeneous data. We have assessed survival in patients  with various forms of cholangiocellular carcinoma and colorectal cancer metastases after minimally invasive liver resections.

Results. For the period 2013–2017 two hundred and fifteen minimally invasive liver resections were performed including 49  robot-assisted and 166 laparoscopic ones. Malignant tumors were in  45% of cases, benign tumors – in 42%, parasitic neoplasms – in  13%. Early results of minimally invasive resections and 70  comparable open liver resections were compared. All procedures  were carried out within the same period at one institution.  Immediate results were significantly better after minimally invasive  liver resections both before pseudo-randomization and after that.  There were 60 pairs of patients after pseudo-randomization. In  groups of minimally invasive and open resections blood loss was 396 (0–3400) and 853 (20–6000) ml respectively, time of surgery – 319  (85–580) and 376 (180–775) min, incidence of severe (Clavien–Dindo II and over) complications – 10% (n = 6) and 23% (n = 14), length of postoperative hospital-stay – 9 (3–90) and 12 (2–39) days, respectively. 3-year survival after mini-invasive liver resections for  colorectal cancer metastases was 70%, various forms of  cholangiocellular carcinoma – 40%.

Conclusion. Conventional liver resections can be successfully performed in laparoscopic or robot-assisted fashion in certain  patients at specialized center of surgical hepatology with sufficient  experience in open and laparoscopic liver surgery.

1. Fretland Å.A., Dagenborg V.J., Bjørnelv G.M.W., Kazaryan A.M., Kristiansen R., Fagerland M.W., Hausken J., Tønnessen T.I., Abildgaard A., Barkhatov L., Yaqub S., Røsok B.I., Bjørnbeth B.A., Andersen M.H., Flatmark K., Aas E., Edwin B.; Oslo-CoMet

2. study group. Laparoscopic versus open resection for colorectal liver metastases: The Oslo-CoMet randomized controlled trial. Ann. Surg. 2018; 267 (2): 199–207. DOI: 10.1097/SLA.0000000000002353.

3. Wong-Lun-Hing E.M., van Dam R.M., van Breukelen G.J., Tanis P.J., Ratti F., van Hillegersberg R., Slooter G.D., de Wilt J.H., Liem M.S., de Boer M.T., Klaase J.M., Neumann U.P., Aldrighetti L.A., Dejong C.H.; ORANGE II Collaborative Group. Randomized clinical trial of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study). Br. J. Surg. 2017; 104 (5): 525–535. DOI: 10.1002/bjs.10438.

4. Ban D., Tanabe M., Ito H., Otsuka Y., Nitta H., Abe Y., Hasegawa Y., Katagiri T., Takagi C., Itano O., Kaneko H., Wakabayashi G. A novel difficulty scoring system for laparoscopic liver resection. J. Hepatobiliary Pancreat. Sci. 2014; 21 (10): 745–753. DOI: 10.1002/jhbp.166.

5. Ciria R., Cherqui D., Geller D.A., Briceno J., Wakabayashi G. Comparative short- term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann. Surg. 2016; 263 (4): 761–777. DOI: 10.1097/SLA.0000000000001413.

6. Buell J.F., Cherqui D., Geller D.A., O'Rourke N., Iannitti D., Dagher I., Koffron A.J., Thomas M., Gayet B., Han H.S., Wakabayashi G., Belli G., Kaneko H., Ker C.G., Scatton O., Laurent A., Abdalla E.K., Chaudhury P., Dutson E., Gamblin C., D'Angelica M., Nagorney D., Testa G., Labow D., Manas D., Poon R.T., Nelson H., Martin R., Clary B., Pinson W.C., Martinie J., Vauthey J.N., Goldstein R., Roayaie S., Barlet D., Espat J., Abecassis M., Rees M., Fong Y., McMasters K.M., Broelsch C., Busuttil R., Belghiti J., Strasberg S., Chari R.S. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann. Surg. 2009; 250 (5): 825–830.

7. Wakabayashi G., Cherqui D., Geller D.A., Buell J.F., Kaneko H., Han H.S., Asbun H., O'Rourke N., Tanabe M., Koffron A.J., Tsung A., Soubrane O., Machado M.A., Gayet B., Troisi R.I., Pessaux P., Van Dam R.M., Scatton O., Abu Hilal M., Belli G., Kwon C.H., Edwin B., Choi G.H., Aldrighetti L.A., Cai X., Cleary S., Chen K.H., Schön M.R., Sugioka A., Tang C.N., Herman P., Pekolj J., Chen X.P., Dagher I., Jarnagin W., Yamamoto M., Strong R., Jagannath P., Lo C.M., Clavien P.A., Kokudo N., Barkun J., Strasberg S.M. Recommendations for laparoscopic liver resection: a report from the Second International Consensus Conference held in Morioka. Ann. Surg. 2015; 261 (4): 619–629. DOI: 10.1097/SLA.0000000000001184.

8. Abu Hilal M., Aldrighetti L., Dagher I., Edwin B., Troisi R.I., Alikhanov R., Aroori S., Belli G., Besselink M., Briceno J., Gayet B., D'Hondt M., Lesurtel M., Menon K., Lodge P., Rotellar F., Santoyo J., Scatton O., Soubrane O., Sutcliffe R., Van Dam R., White S., Halls M.C., Cipriani F., Van der Poel M., Ciria R., Barkhatov L., Gomez-Luque Y., Ocana-Garcia S., Cook A., Buell J., Clavien P.A., Dervenis C., Fusai G., Geller D., Lang H., Primrose J., Taylor M., Van Gulik T., Wakabayashi G., Asbun H., Cherqui D. The Southampton Consensus Guidelines for laparoscopic liver surgery: from indication to implementation. Ann. Surg. 2017; Oct 23. DOI: 10.1097/SLA.0000000000002524.

9. Alikhanov R.B., Efanov M.G., Kazakov I.V., Melekhina O.V., Kim P.P., Vankovich A.N. Laparoscopic segmtnectomy in patients with liver cirrhosis. Doctor.ru. Special edition. 2015; 1 (11): 31–33. (In Russian)

10. Efanov M., Alikhanov R., Tsvirkun V., Kazakov I., Melekhina O., Kim P., Vankovich A., Grendal K., Berelavichus S., Khatkov I. Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB (Oxford). 2017; 19 (9): 818–824. DOI: 10.1016/j.hpb.2017.05.003.

11. Efanov M., Alikhanov R., Cvirkun V., Kazakov I., Melekhina O., Kim P., Vankovich A., Khatkov I. Radical robot-assisted liver resection for alveolar echinococcosis. CRSLS. 2015; e2015.00021. DOI: 10.4293/CRSLS.2015.00021.

12. Grjibovski A.M., Ivanov S.V., Gorbatova M.A., Dyusupov A.A. Propensity score matching as a modern statistical method for bias control in observational studies with binary outcome. Ekologiya cheloveka. 2016; 5: 50–64. (In Russian)

13. Martínez-Cecilia D., Cipriani F., Vishal S., Ratti F., Tranchart H., Barkhatov L., Tomassini F., Montalti R., Halls M., Troisi R.I., Dagher I., Aldrighetti L., Edwin B., Abu Hilal M. Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann. Surg. 2017; 265 (6): 1192–1200. DOI: 10.1097/SLA.0000000000002147.

14. Scuderi V., Barkhatov L., Montalti R., Ratti F., Cipriani F., Pardo F., Tranchart H., Dagher I., Rotellar F., Abu Hilal M., Edwin B., Vivarelli M., Aldrighetti L., Troisi R.I. Outcome after laparoscopic and open resections of posterosuperior segments of the liver. Br. J. Surg. 2017; 104 (6): 751–759. DOI: 10.1002/bjs.10489.

15. Adam R., De Gramont A., Figueras J., Guthrie A., Kokudo N., Kunstlinger F., Loyer E., Poston G., Rougier P., Rubbia- Brandt L., Sobrero A., Tabernero J., Teh C., Van Cutsem E. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012; 17 (10): 1225–1239. DOI: 10.1634/theoncologist.2012-0121.

16. Tian Z.Q., Su X.F., Lin Z.Y., Wu M.C., Wei L.X., He J. Metaanalysis of laparoscopic versus open liver resection for colorectal liver metastases. Oncotarget. 2016; 7 (51): 84544–84555. DOI: 10.18632/oncotarget.13026.

17. Zhang X.L., Liu R.F., Zhang D., Zhang Y.S., Wang T. Laparoscopic versus open liver resection for colorectal liver metastases: A systematic review and meta- analysis of studies with propensity score-based analysis. Int. J. Surg. 2017; 44: 191–203. DOI: 10.1016/j.ijsu.2017.05.073.

18. Ratti F., Cipriani F., Ariotti R., Gagliano A., Paganelli M., Catena M., Aldrighetti L. Safety and feasibility of laparoscopic liver resection with associated lymphadenectomy for intrahepatic cholangiocarcinoma: a propensity score- based case-matched analysis from a single institution. Surg. Endosc. 2016; 30 (5): 1999–2010. DOI: 10.1007/s00464-015-4430-4.

19. Zimmitti G. Current role of minimally invasive radical cholecystectomy for gallbladder cancer. Gastroenterol. Res. Pract. 2016; 2016: 7684915.