Robotic liver resection for non colorectal metastases: how to deal with it. A multi-center case series

Background: The state of the art for robotic liver metastasis resection is not yet well-defined and remains a topic of debate. While hepatic resection for colorectal liver metastases (CRLM) is recognized as a valuable approach for systemic disease control, hepatectomy for non-colorectal liver metastases (NCLM) has shown varied outcomes. Materials and methods: A retrospective analysis was conducted on patients who underwent robotic liver resections for NCLM from 2012 to 2023 across seven European hospital centers. Preoperative, intraoperative, and postoperative data were collected for each patient, including overall and disease-free survival. Results: Distribution based on primary tumor histology revealed a prevalence of breast carcinoma (38%) and neuroendocrine tumors (NET) (17.7%) compared to other primaries. Among the hepatic resections, 58 (45.8%) were wedge resections, 8 (10%) were segmentectomies, 12 (9.5%) were bisegmentectomies, and 1 (0.8 %) was a major hepatectomy. The majority of liver resections were assessed on an intermediate level of difficulty based on Tampa Score. The mean operative time was 226 min (range 90-480). There were 3 conversions to the open approach (3.8%). Severe complications (Clavien Dindo ≥3) occurred in 3 patients (5.1 %). The mean hospital stay was 5.3 days. The 1,3 and 5-year overall survival (OS) was 100%, 70% and 50%, respectively. The 1,3 and 5-year disease-free survival (DFS) was 75%, 40% and 30%, respectively. Conclusions: The role of robotic liver resections for non colorectal metastasis remains challenging and unclear. Our findings indicate promising oncological outcomes that surpass existing literature, suggesting potential advantages of the robotic approach. Randomized controlled trials are still missing but essential to validate the safety and feasibility of the robotic approach for NCLM treatment.