RF104 - Synchronous Robotic Resection of Primary Colorectal Tumors and Liver Metastases: A Single-Center Experience

Purpose/Background: Recent studies have demonstrated the feasibility of performing simultaneous colorectal and hepatic resections for CRLM, with some reports suggesting acceptable morbidity rates. However, these studies often involve open or laparoscopic approaches, and the application of robotic surgery in this complex setting remains relatively underreported. Robotic surgery, with its enhanced visualization, dexterity, and precision, may offer advantages in performing these technically demanding procedures, particularly in achieving sound resections from an oncological point of view while simultaneously mitigating surgical trauma.

Methods/Interventions: The medical records of 35 patients that were operated on with simultaneous robotically assisted resection of primary colon or rectal cancer and liver metastases CRLM were retrieved and analyzed. All patients were operated on between January 2019 and May 2025.

Results/Outcomes: The median age was 62 years [IQR: 47.5-71], with 26 being male (74.3%) and 9 female (25.7%). Seven patients were ASA II (20%), and 24 patients were ASA grade III (68.57%). Two patients had 2 synchronous primary tumors (5.7%), and the rectum was the site of primary lesion in 30 patients (57.14%). The primary tumor emerged from adenocarcinoma in 33 patients. The median size for liver metastases was 2 cm [1-3], median size of the largest tumor was 6.6 cm [1.15-2.53], and the total number of liver metastases was 90. Five patients underwent major liver resections (14.3%). The median total operative time was 487 minutes [394-571], median of colorectal operative time was 309 [199.5-343], and median of liver operative time was 190.5 minutes [141.75-243.25]. The median estimated blood loss was 405 ml [50-200]. The median follow-up time was 15.87 months [6.21-40-53]. The median length of hospital stay was 5 days [4-7]. Negative resection margin R0 was achieved in 34 (97.14%) patients. Two patients had major postoperative complications (13.3%) with Clavien-Dindo ≥3, with an anastomotic leak occurring in one patient (2.86%). There were no intrahospital or postoperative mortalities registered within 30-90 days.

Conclusion/Discussion: This study demonstrates that synchronous robotic-assisted resection for CRLM is safe and feasible. The decision remains patient-specific and should be guided by multidisciplinary team discussions to optimize oncologic and perioperative outcomes.