Multivisceral Resection in Robotic Liver Surgery

Minimally invasive surgery techniques are expanding in utilization in liver resections and now include robotic approaches. Robotic liver resection has been demonstrated to have several benefits, including surgeon ergonomics, wrist articulation, and 3D visualization. Similarly, for multivisceral liver resections, the use of minimally invasive techniques has evolved and expanded from laparoscopy to robotics. The aim of this article is to review the literature and describe multivisceral resections, including hepatectomy, using a robotic technique. We describe over 50 published cases of simultaneous robotic liver resection with colon or rectal resection. In addition, we describe several pancreatectomies performed with liver resection and one extra-abdominal pulmonary resection with liver resection. In total, these select reported cases at experienced centers demonstrate the safety of robotic multivisceral resection in liver surgery with acceptable morbidity and rare conversion to open surgery. As robotic technology advances and experience with robotic techniques grows, robotic multivisceral resection in liver surgery should continue to be investigated in future studies.

Evaluation of anemia as a postoperative risk factor in the evolution of patients with gastric resection for malignancies

Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.

Long term outcomes after pancreaticodoudenectomy: a single center experience from Pakistan

Objective: Pancreaticodoudenectomy (PD) remains a challenging surgical procedure. PD outcomes remain under reported from Pakistan. The objective of the current study was to report PD outcomes from a large single center patient cohort. Methods: A total of 155 patients who underwent PD between 2011 and 2019 were included. Outcome was assessed based on morbidity, in hospital mortality and survival. Results: Mean age was 56.8 ±13.5 years (range=8-85). Male to female ratio was (103/52)1.9:1. Overall morbidity was 84/155 (54.2%). Grade B and C pancreatic fistula (PF) were seen in 5 (3.2%) and 6 (3.8%) patients. In hospital mortality was 5/155 (3.2%). The estimated 5 year overall survival (OS) was 11% and 23% for pancreatic and non-pancreatic cancers (P=0.2). The estimated 3 year OS was lower with multivisceral resection (23% vs 5%, P <0.001), advanced tumors (40% vs 11%)(P=0.008) , nodal involvement (34% vs 12%)(P=0.04) and positive microscopic margins (30% vs 8%, P=0.006). Conclusion: Short and long term outcomes comparable to international high volume centers for PD can be achieved with site specific focus in hepatopancreatobiliary surgery. Continuous...

The outcomes of multivisceral resection for primary T4b colorectal cancer in a tertiary referral center: A propensity score matching analysis.

IntroductionA multivisceral resection (MVR) is often necessary for patients with colorectal cancer (CRC) as the tumor must be removed en bloc with the infiltrated tissues. The outcomes of MVR are variably presented in the literature. This study aimed to analyze mortality and morbidity of MVR in patients with CRC.Material and methodsThis retrospective study was performed using the Department of General and Colorectal Surgery database of 2204 patients operated on for CRC. Patients with MVR due to stage pT4b primary CRC were the study group. Patients with no sign of intraoperative infiltration into contiguous structures who had undergone a traditional resection qualified for the control group. Mortality and morbidity for both groups were compared using a propensity score matching analysis.ResultsPatients with no sign of intraoperative infiltration into contiguous structures who had undergone a traditional resection qualified for the control group, while 117 patients with MVR due to stage pT4b primary CRC were included in the study group. Early post-operative mortality was not significantly increased in the MVR (3.4%vs.1.4%;p=0.284). The mean operative time was significantly longer in the MVR (p<0.001). The five-year absolute survival rate was significantly higher in the MVR group (76.7%) than in control (57.0%;p=0.004).ConclusionsMVR in pT4 CRC is not linked to a higher risk of significant post-operative complications compared to standard resections. Patients with CRC with involvement of contiguous structures who undergo an MVR do not appear to have worse long-time outcome than those who do not have involvement of contiguous structures.