Feasibility of Robotic Surgical Approach in Peritoneal Carcinomatosis

Abstract

Introduction: Advances in robotic instrumentation have facilitated minimally invasive completion of complex cancer operations. The objective of this study is to determine the feasibility of robotic approach for cytoreduction (R-CRS) for peritoneal carcinomatosis in a series of 16 consecutive cases.

Methods: Single institution retrospective study of consecutive patients with peritoneal carcinomatosis deemed appropriate for R-CRS after multidisciplinary review between 2017 and 2022. Feasibility was defined as the proportion of patients in whom complete cytoreduction was achieved without conversion to open.

Results: A total of 16 patients (median interquartile range [IQR]: age 60 ys [45.8-70.5], body mass index 29 [24.5-33.6], peritoneal carcinomatosis index 5 [2.8-6.3]) underwent R-CRS of which six also received hyperthermic intraperitoneal chemtotherapy. Seven patients had gastrointestinal primary cancers (3 colorectal, 3 appendiceal, 1 small bowel neuroendocrine); and nine had gynecologic cancers (7 ovarian, 2 endometrial). Median operative time was 6.0 h (IQR: 5.0-9.0), and median estimated blood loss was 87.5 mL (IQR: 30.0-262.5). Robotic procedures included: pelvic tumor debulking 12 (75%), omentectomy 8 (50%), peritonectomy 6 (38%), large bowel resection 6 (37%), retroperitoneal mass resection 4 (25%), and hepatectomy 3 (19%). Median length of stay was 3.5 ds (IQR: 1.8-5.3) for the whole cohort and only 2 ds (IQR: 1.0-5.5) for patients who did not undergo hyperthermic intraperitoneal chemotherapy. Feasibility rate was 87.5%, whereas conversion, 30-d complication, and 30-d mortality rates were 12.5%, 18.8%, and 0%, respectively.

Conclusions: Our experience with R-CRS demonstrates feasibility of the approach with a potential for benefit in short-term outcomes in a carefully selected cohort of patients when performed at a high-volume robotic surgery center.

Keywords: Cytoreductive surgery; HIPEC; Minimally invasive surgery; Peritoneal carcinomatosis; Robotic surgery.