Objective: To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy(L-MH). Background: Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether robotic major hepatectomy (R-MH) is superior to laparoscopic major hepatectomy (L-MH). Methods: This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience/ volume, perioperative outcomes and tumor characteristics were collected and analyzed. 1:1 propensity score matched (PSM) and coarsened-exact matched (CEM) analysis was performed to minimize selection bias between both groups. Results: A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM, (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss (PSM:200.0 [IQR:100.0, 450.0] ml vs. 300.0 [IQR:150.0, 500.0] ml; P=0.012; CEM:170.0 [IQR: 90.0, 400.0] ml vs. 200.0 [IQR:100.0, 400.0] ml; P=0.006), lower rates of Pringle maneuver application (PSM: 47.1% vs. 63.0%; P<0.001; CEM: 54.0% vs 65.0%; P=0.007) and open conversion (PSM: 5.1% vs. 11.9%; P<0.001; CEM: 5.5% vs. 10.4%, P=0.04) compared to L-MH. On subset analysis of 1273 cirrhotic patients, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs. 29.9%; P=0.02; CEM 10.4% vs. 25.5%; P=0.02) and shorter postoperative stay (PSM: 6.9 [IQR: 5.0, 9.0] days vs. 8.0 [IQR: 6.0 11.3] days; P<0.001; CEM 7.0 [IQR: 5.0, 9.0] days vs. 7.0 [IQR: 6.0, 10.0] days; P=0.047). Conclusion: This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application and conversion to open surgery.
Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases / Q. Liu, W. Zhang, J.J. Zhao, N.L. Syn, F. Cipriani, M. Alzoubi, D.L. Aghayan, T. Siow, C. Lim, O. Scatton, P. Herman, F.F. Coelho, M.V. Marino, V. Mazzaferro, A.K.H. Chiow, I. Sucandy, A. Ivanecz, S. Choi, J.H. Lee, M. Prieto, M. Vivarelli, F. Giuliante, B.D. Valle, A. Ruzzenente, C. Yong, Z. Chen, M. Yin, C. Fondevila, M. Efanov, Z. Morise, F. Di Benedetto, R. Brustia, R.D. Valle, U. Boggi, D. Geller, A. Belli, R. Memeo, S. Gruttadauria, A. Mejia, J.O. Park, F. Rotellar, G. Choi, R. Robles-Campos, X. Wang, R.P. Sutcliffe, M. Schmelzle, J. Pratschke, C. Tang, C.C.N. Chong, K. Lee, J. Meurs, M. D'Hondt, K. Monden, S. Lopez-Ben, T.P. Kingham, A. Ferrero, G.M. Ettorre, G.B.L. Sandri, M. Saleh, D. Cherqui, J. Zheng, X. Liang, A. Mazzotta, O. Soubrane, G. Wakabayashi, R.I. Troisi, T. Cheung, Y. Kato, A. Sugioka, M. D'Silva, H. Han, P.P. Nghia, T.C.D. Long, B. Edwin, D. Fuks, K. Chen, M.A. Hilal, L. Aldrighetti, R. Liu, B.K.P. Goh. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - (2023 Apr 14), pp. 1-10. [Epub ahead of print] [10.1097/SLA.0000000000005855]
Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases
V. Mazzaferro;
2023
Abstract
Objective: To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy(L-MH). Background: Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether robotic major hepatectomy (R-MH) is superior to laparoscopic major hepatectomy (L-MH). Methods: This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience/ volume, perioperative outcomes and tumor characteristics were collected and analyzed. 1:1 propensity score matched (PSM) and coarsened-exact matched (CEM) analysis was performed to minimize selection bias between both groups. Results: A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM, (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss (PSM:200.0 [IQR:100.0, 450.0] ml vs. 300.0 [IQR:150.0, 500.0] ml; P=0.012; CEM:170.0 [IQR: 90.0, 400.0] ml vs. 200.0 [IQR:100.0, 400.0] ml; P=0.006), lower rates of Pringle maneuver application (PSM: 47.1% vs. 63.0%; P<0.001; CEM: 54.0% vs 65.0%; P=0.007) and open conversion (PSM: 5.1% vs. 11.9%; P<0.001; CEM: 5.5% vs. 10.4%, P=0.04) compared to L-MH. On subset analysis of 1273 cirrhotic patients, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs. 29.9%; P=0.02; CEM 10.4% vs. 25.5%; P=0.02) and shorter postoperative stay (PSM: 6.9 [IQR: 5.0, 9.0] days vs. 8.0 [IQR: 6.0 11.3] days; P<0.001; CEM 7.0 [IQR: 5.0, 9.0] days vs. 7.0 [IQR: 6.0, 10.0] days; P=0.047). Conclusion: This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application and conversion to open surgery.
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Open Access dal 15/04/2024
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