Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Trattamento mininvasivo delle metastasi epatiche da carcinoma del colon retto. Studio Multicentrico degli outcomes della Chirurgia Robotica vs la Chirurgia Laparoscopica

Background: The liver is the most common site of metastatic spread of colorectal cancer (CRC). Approximately 15–25% of patients with CRC will have distant metastases at the time of primary diagnosis and about 50% of them will develop recurrences within the first 2 years after surgery. Liver resection is the standard of treatment for colorectal Liver Metastases (CRLM). Parenchyma-sparing approach should be preferred whenever suitable in order to allow future re-do hepatectomy and to garantee preserving future liver remnant (FLR). Interest in minimally invasive liver surgery (MILS) has increased over the last decades due to the possibility of reducing postoperative pain and disability, shortening the hospital stay and the time required for functional recovery. Nevertheless the role of robotic liver surgery is still under debate, especially with regard to oncological outcomes. The aim of our study was to evaluate the short- and longterm outcomes of laparoscopic liver resections (LLR ) versus robotic liver resection (RLR) for the treatment of CRLM. Matherials and methods: we retrospectively analyzed 406 consecutive patients with CRLM who underwent LLR (328) vs RLR (78). Patients were divided into LLR and RLR groups and then, perioperative, postoperative and oncological outcomes were analyzed. Propensity score-matched analysis was used to match groups for preoperative characteristics, liver functions tests, metastases postions and surgical procedure. Results: After propensity score matching, 116 patients were enrolled, 58 in the LLR group and 58 in the RLR group. There were no significant differences between the two groups in terms of complications, hospital stay, post-operative mortality, oncological outcomes, recurrence and overall survival. Conclusions: our study and available evidences suggest that oncologic results after robotic liver resection are comparable to laparoscopic approaches when performed in experienced centers, robotic assisted surgery is accurate in terms of R0 rates and disease-free surgical margins. Laparoscopic and robotic-assisted hepatectomies are both technically demanding but safe and feasible. Despite high cost and the lack of diffusion between many hepatobiliary surgeons, robotic liver surgery continues evolving and our results support the constant implementation of robotic programs.