Study shows liver surgery to remove cancer can now be a safe, outpatient procedure

A new study guided by a surgeon at City of Hope, one of the largest cancer research and treatment organizations in the United States, demonstrates that robotic liver surgery can be a safe, outpatient procedure. In fact, 8% of the patients sampled in the analysis were discharged to go home on the same day.

The research is published in the Journal of the American College of Surgeons.

“We have made so much progress in liver cancer. We can now deliver more cures and use less invasive treatment options. This study is proof that for the right patients and with the right tools—meaning robotic surgery—we can get people through a liver operation quicker and toward recovery and normal life faster,” said Yuman Fong, M.D., senior author of the study, Sangiacomo Family Chair in Surgical Oncology at City of Hope and director of City of Hope’s Center for Surgical Innovation.

In the retrospective study, physician researchers evaluated patient data (n=4,408) between 2013 and 2023 from three American cancer centers, including City of Hope, and three Dutch centers. They identified 307 patients who had received robotic liver surgery as outpatients, which was defined as a procedure requiring less than two nights of hospital stay.

While some patients had liver or biliary cancer in a single organ, most patients (n=150) had colorectal cancer that had spread to the liver. Other diagnoses included cancers of the neuroendocrine system, breast and lung that had spread to the liver.

The medical community has been debating about whether liver surgery can and should be a robotic procedure because liver surgery is complex. Bleeding or other surgical complications often arise, requiring admission into the intensive care unit.

“Not long ago, liver resections were considered an open surgery procedure that requires a fairly big incision. Patients oftentimes need to stay in the hospital five to 14 days, and they’re often admitted to intensive care units. Even after leaving the hospital, recovery from such surgeries will often take three to six weeks. In this study of robotic surgery, we found that by one week many of these patients were able to take 5,000 to 6,000 steps,” Fong said.

It is worth noting that the readmission rate of open liver surgery is 20-25% at most major cancer centers, Fong added, yet the readmission rate for robotic hepatectomy was 1.6% in this retrospective analysis of data from six centers in two nations.

On average, readmission cost was $15,200 in 2018. Looking at the big picture, the cost of unplanned hospital readmission in the United States is estimated to be around $30 billion, according to a 2021 article in the Annals of Translational Medicine.

City of Hope embraced robotic surgery very early—in the 2000s, when many in the medical community were skeptics about whether robotic surgery is a safe technique for cancer surgery. Now almost every surgery division at City of Hope uses robotic surgery—from the commonplace robotic prostate surgery to the leading-edge robotic liver surgery. In total, City of Hope surgeons have performed more than 16,000 robotic surgeries.

“Through the entire gamut, City of Hope is looking at different cancers to develop best practices for identifying patients who will benefit the most from robotic surgeries, as well as to clearly state what type of patients with cancer should still receive open surgery to have the best cancer outcome,” Fong said.