Robotic Hepatectomy May Demonstrate Safety in Liver Cancer

Findings from a retrospective study showed that outpatient robotic hepatectomies resulted in no mortalities across 307 procedures.

Robotic hepatectomies demonstrated greater safety compared with incision-based procedures, with approximately 8% of patients with liver cancer discharged to go home on the same day, according to findings from a retrospective study published in Journal of the American College of Surgeons.¹

Patients treated by robotic hepatectomies had complication and re-admission rates of 2% and 1.6%, respectively. There were no reported mortalities.

“We have made so much progress in liver cancer. We can now deliver more cures and use [fewer] invasive treatment options. This study is proof that for the right patients and with the right tools—meaning robotic surgery—we can get people through a liver operation quicker and toward recovery and normal life faster,” senior study author Yuman Fong, MD, Sangiacomo Family Chair in Surgical Oncology and director of the Center for Surgical Innovation at City of Hope, said in a press release on this study.²

According to Fong, re-admission rates were considerably lower among patients who received robotic hepatectomy, as open liver surgery typically correlated with a 20% to 25% re-admission rate at most major cancer centers. Robotic hepatectomies resulted in a re-admission rate more than 10 times lower than incision-based surgeries.

In the retrospective study, patient data between 2013 and 2023 were evaluated by physician researchers in 3 American and 3 Dutch cancer centers. Additionally, 307 patients were identified as undergoing outpatient robotic hepatectomies, and 150 had colorectal cancer that metastasized to the liver.

Of the 307 patients, 26 (8.5%) were discharged on the same day, and 281 (91.5%) stayed for an additional night. Complications occurred in 6 patients, including 2 wound infections requiring antibiotics, 3 abscesses resulting in re-admission, and 1 readmission for failure to thrive. Five of 6 complications resulted in re-admissions.

“Not long ago, liver resections were considered an open surgery procedure that requires a fairly big incision. Patients oftentimes need to stay in the hospital 5 to 14 days, and they’re often admitted to intensive care units. Even after leaving the hospital, recovery from such surgeries will often take 3 to 6 weeks. In this study of robotic surgery, we found that by 1 week many of these patients were able to take 5000 to 6000 steps,” Fong said.²

Surgical techniques varied across the 6 centers, with no efforts made to standardize surgical techniques. Information was extracted from databases and hospital charts, and investigators evaluated safety by examining complications. Medical records beyond hospital charts were examined to identify re-admissions.

For the duration of the study, 27% of hepatectomies were robotically performed (n = 1217/4408). The 307 outpatient hepatectomies represented 25% of all robotic hepatectomies within the same period.

Patients had a median age of 60 years (range, 18-93). Of the 307 patients, 60 had hepatocellular or biliary cancer, with the remainder having a form of metastatic disease, including colorectal metastases, metastatic neuroendocrine tumors, metastatic breast cancer, and metastatic lung disease, among others. In total, 187 patients (61%) had previous abdominal surgery. Furthermore, 200 patients (65%) had comorbidities, of whom 21% had cardiovascular disease, 10% had diabetes, and 10% had cirrhosis.

Overall, 194 (63%) patients had a single segmental resection, 90 (29%) had a 2-segment resection, and 23 (8%) had surgeries involving 3 or more segments. A single piece of liver was removed from 264 (86%) patients, and 43 (14%) patients had more than 1 piece of liver removed.

References

1. Park JO, Lafarro K, Hagendoorn J, et al., Outpatient and ambulatory extended recovery robotic hepatectomy: Multinational study of 307 cases. Journal of the American College of Surgeons. Published online May 21, 2024. doi: 10.1097/XCS.0000000000001107
2. Logsdon Z. New City of Hope study shows liver surgery to remove cancer can now be a safe, outpatient procedure. News Release. City of Hope. June 10, 2024. Accessed June 12, 2024. https://tinyurl.com/f94zwd2k