Ambulatory colectomy for cancer: Results from a prospective bicentric study of 177 patients.

BACKGROUND: The implementation of an Enhanced Recovery After Surgery programme after colectomy reduces postoperative morbidity and shortens the length of hospital stay. OBJECTIVE: To evaluate the short and midterm outcomes of ambulatory colectomy for cancer. METHODS: This was a two-centre, observational study of a database maintained prospectively between 2013 and 2021. Short-term outcome measures were complications, admissions, unplanned consultations and readmission rates. Midterm outcome measures were the delay between surgery and initiation of adjuvant chemotherapy, length of disease-free survival and 2-year disease-free survival rate. RESULTS: A total of 177 patients were included. The overall morbidity rate was 15% and the mortality rate was 0%. The admission rate was 13% and 11% patients left hospital within 24 h of surgery. The readmission rate was 9% and all readmissions occurred before postoperative Day 4. Eight patients underwent repeat surgery because of anastomotic fistula (n = 7) or anastomotic ileocolic bleeding (n = 1). These patients had an uneventful recovery. Sixty-one patients required adjuvant chemotherapy with a median delay between surgery and chemotherapy initiation of 35 days. CONCLUSIONS: Ambulatory colectomy for cancer is feasible and safe. Adjuvant chemotherapy could be initiated before 6 weeks postsurgery. The ambulatory approach may be a step forward to further improve morbidity and oncologic prognosis.

Robotic Left Hepatectomy Extended to Caudate Lobe and Common Biliary Duct for Hilar Cholangiocarcinoma.

BACKGROUND: The safety and efficiency of minimally invasive approaches for liver resection have been confirmed (Wakabayashi in Ann Surg, 2015). However, laparoscopy suffers from several limitations due to technical difficulties, particularly for difficult hepatectomy with lymphadenectomy, biliary, and vascular reconstruction. Robotic assets could improve accessibility for difficult liver resections (Liu in World J Gastroenterol 25: 1432-1444), (Chou in Zhonghua Wai Ke Za Zhi 58: 230-234, 2020). PATIENTS AND METHODS: A 56-year-old woman was treated for a hilar cholangiocarcinoma, Bismuth 3b. RESULTS: A robotic anatomical left hepatectomy extended to caudate lobe and common biliary duct was decided. A Da Vinci X robot was used. The procedure was performed with a second surgeon positioned between the patient's legs. Left hepatectomy was extended to common biliary duct and caudate lobe. A four-hands parenchymal dissection (Camerlo in J Robot Surg, 2020) was performed with laparoscopic ultrasonic dissector and robotic irrigated bipolar, guided by indocyanine green. Axis of deep transection line was maintained using the EndoWrist function and exposure with a fourth arm. No pedicle clamping was necessary. Segment 1 was released with a mediocaudal approach. Lateral portal vein resection was performed after parenchymal transection was completed. Hepaticojejunostomy was done separately to the right anterior and posterior biliary duct. Operation time was 420 min, and estimated blood loss was 100 ml. The postoperative course was uneventful. The patient was discharged on postoperative day 8. Pathological findings revealed a 15-mm hilar cholangiocarcinoma with complete resection and eight lymph nodes, all negative. CONCLUSIONS: Robotic approaches could improve accessibility to minimally invasive liver resection of Klatskin tumor.

Robotic right hepatectomy for giant hepatocellular adenoma - With video.

BACKGROUND: The safety and efficiency of mini-invasive approach for liver resection have been confirmed. However, laparoscopic approach suffers from several limits due to technical difficulties particularly for voluminous tumor. Robotic approach could improve accessibility of these difficult tumors. METHODS: A 29-year-old woman was treated for a giant telangiectasic adenoma [1] of the right liver measuring 20 cm. RESULTS: A robotic anatomical right hepatectomy was decided [2]. Da Vinci X robot was used. The procedure was performed with a second surgeon positioned between the patient's legs using suction/irrigation device and ultrasonic dissector through laparoscopic ports [3]. A first hilar approach allows individualization of right hepatic artery and portal vein. Robotic irrigated bipolar coagulation and laparoscopic ultrasonic dissector was used for parenchymal transection. Operation time was 290 min, and estimated blood loss was 150 ml. Postoperative course was uneventful. The patient was discharged on postoperative day eight. CONCLUSIONS: Robotic approach could improve accessibility to minimally invasive liver resection of voluminous tumor.

Is percutaneous destruction of a solitary liver colorectal metastasis as effective as a resection?

BACKGROUNDS/AIMS: Surgical resection remains the gold standard in the treatment of colorectal liver metastasis. However, when a patient presents with a deep solitary colorectal liver metastasis (S-CLM), the balance between the hepatic volume sacrificed and the S-CLM volume is sometimes clearly unappropriated. Thus, alternatives to surgery, such as operative and percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA), have been developed. This study aimed to identify the prognostic factors affecting survival of patients with S-CLM who undergo curative-intent liver resection or local destruction (RFA or MWA). METHODS: We retrospectively identified 211 patients with synchronous or metachronous S-CLM who underwent either surgical resection (n=182) or local destruction (RFA or MWA; n=29) according to the S-CLM size, location, and surrounding Glissonian structures. RESULTS: Patients who underwent RFA or MWA had S-CLM of a smaller size than those who underwent resection (mean 19.7 vs. 37.3 mm, p<.01). The 1-, 3-, and 5-year overall survival (OS) rates were 97.4%, 84.9%, and 74.9%, respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 77.9%, 47%, and 38.9%, respectively. S-CLM located in the left liver (p=.04), S-CLM KRAS mutation (p<.01), and extra-hepatic recurrence (p<.01) were identified as independent poor risk factors for overall survival (OS); the OS and DFS were comparable in patients with surgical procedure or percutaneous MWA. CONCLUSIONS: In eligible S-CLM cases, percutaneous MWA seems to be as oncologically efficient as surgical resection and should be include in the decision-tree for treatment strategies.