From the Guidelines
The liver lesions can potentially be removed robotically, but the decision should be made by a hepatobiliary surgeon after reviewing all imaging studies and considering the patient's overall health status. The report identifies two hyperenhancing lesions in the right hepatic lobe consistent with metastases (a 1.2 cm lesion in segment 7 and a 0.6 cm lesion in segment 6), which are stable in size. According to the guidelines for perioperative care for liver surgery, robotic liver resection seems to be feasible by hepato-biliary surgeons with advanced training, especially for lesions located in the postero-superior segments 1. However, the decision for robotic versus open surgical approach would need to be made after considering the exact location of the lesions, their proximity to major blood vessels, and the patient's overall health status.
Some key factors to consider in the decision-making process include:
- The location and size of the lesions
- The presence of the pancreatic neuroendocrine tumor near the resection margin
- The patient's history of chronic pancreatitis, splenomegaly, and gastric varices due to splenic vein occlusion
- The results of the recommended MRI liver protocol with Eovist for full characterization of the lesions
The American College of Radiology (ACR) Appropriateness Criteria for suspected liver metastases suggest that surgical resection is the most effective treatment for liver metastasis, particularly in colorectal cancer 1. The European Society for Medical Oncology (ESMO) consensus guidelines for management of patients with colon and rectal cancer also emphasize the importance of a personalized approach to clinical decision making, considering factors such as the biology of the disease and the patient's eligibility for surgery 1.
In this case, the patient's liver lesions are consistent with metastases, and the decision for robotic versus open surgical approach should be made after careful consideration of all relevant factors, including the potential benefits and risks of each approach, as well as the patient's overall health status and preferences. A hepatobiliary surgeon with advanced training and experience in robotic liver resection should be consulted to determine the best course of treatment.
From the Research
Liver Lesion Removal
- The liver lesions can be removed robotically, as indicated by several studies 2, 3, 4, 5, 6.
- Robotic liver resection is associated with lower perioperative morbidity and shorter hospital stay compared to open surgery 2.
- The robotic platform offers advantages such as a shortened learning curve, the ability to complete more extensive or complex minimally invasive operations, and integrated fluorescence guidance 2, 4, 6.
Technical Aspects
- Robotic liver surgery allows for precise dissection and microsuturing, even in narrow operative fields, enabling better dissection of the hepatic hilum, fine lymphadenectomy, and biliary reconstruction 6.
- The implementation of near-infrared fluorescence with indocyanine green (ICG) allows for a more accurate recognition of vascular and biliary anatomy 6.