Robotic Liver Surgery in Patients with Metabolic Syndrome

Robotic Liver Surgery in Patients with Metabolic Syndrome

Metabolic syndrome is a combination of multiple health conditions including abdominal obesity, insulin resistance, dyslipidemia, and hypertension, which lead to an increased risk of cardiovascular disease, stroke, and diabetes mellitus. Fatty liver disease secondary to metabolic liver dysfunction not related to alcohol consumption, namely Non-Alcoholic Fatty Liver Disease (NAFLD), is a common liver manifestation of metabolic syndrome, which can progress to Non-Alcoholic Steato-Hepatitis (NASH), cirrhosis, and eventually hepatocellular carcinoma (Liver Cancer). As the risk factors for metabolic syndrome include a sedentary lifestyle, increased abdominal girth, and insulin resistance, the incidence of metabolic syndrome and NASH are steadily rising in the United States. Liver cirrhosis and liver cancer secondary to NAFLD are now becoming the leading cause of needing liver resection or liver transplantation.

Treatment with an intention to achieve cure in liver cancer relies on surgical management which includes either liver resection or liver transplantation. Liver transplantation is however limited to a small number of patients that fall within the strict Milan criteria (a single tumor smaller than 5 cm or 3 tumors, each smaller than 3 cm). Consequently, liver resection remains the cornerstone for treatment of hepatocellular carcinoma liver cancer, especially in patients with preserved liver function.

Recent advances in the field of Minimally Invasive Surgery pioneered by Dr. Sucandy and his colleagues have allowed robotic complex major liver resections to be done with excellent short-term outcomes, even in patients with baseline liver abnormalities. Dr. Sucandy designed a study to examine the outcomes after robotic liver cancer resections in patients with metabolic syndrome, who often present with fatty liver disease. A secondary aim was to determine whether the use of the robotic system alters the perioperative course compared to that of a control group without metabolic syndrome.

The findings showed there were no differences between patients with and without metabolic syndrome in terms of operative duration, blood loss, conversion to “open”, postoperative complications, in-hospital death, length of stay, and readmission rate. There was no difference in 1-year, 2- year and 3-year overall survival in patients with or without metabolic syndrome after robotic liver cancer resection. These important findings suggested that in experienced hands of a robotic liver surgeon, the use of robotic technology leads to an excellent outcome, despite baseline fatty liver disease, and higher metabolic comorbidities.

At the 2022 Southeastern Surgical Congress in Nashville, Dr. Sucandy and his colleagues emphasized the need of finding an experienced team to select and perform the liver tumor operation since this is an absolute key for success. An extensive experience in robotic surgery is important. A high-volume surgeon produces better outcomes. Dr. Sucandy is a high-volume robotic liver surgeon in Tampa Bay area. 20% of liver cancer patients come from out of state. A wrong patient selection can lead into a fatal postoperative liver failure. A suboptimal patient evaluation and operative strategy can also lead to major postoperative complications. In our advanced liver surgery center in Tampa, we are equipped to handle patients with metabolic syndrome and fatty liver disease, who need a liver tumor operation. Dr. Sucandy had become a mentor to many who are interested in learning various techniques of advanced liver surgery, both nationally and internationally in the past 5 years.