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 / Liu, Qu; Zhang, Wanguang; Zhao, Joseph J; Syn, Nicholas L; Cipriani, Federica; Alzoubi, Mohammad; Aghayan, Davit L; Siow, Tiing-Foong; Lim, Chetana; Scatton, Olivier; Herman, Paulo; Coelho, Fabricio Ferreira; Marino, Marco V; Mazzaferro, Vincenzo; Chiow, Adrian K H; Sucandy, Iswanto; Ivanecz, Arpad; Choi, Sung-Hoon; Lee, Jae Hoon; Prieto, Mikel; Vivarelli, Marco; Giuliante, Felice; Valle, Bernardo Dalla; Ruzzenente, Andrea; Yong, Chee-Chien; Chen, Zewei; Yin, Mengqiu; Fondevila, Constantino; Efanov, Mikhail; Morise, Zenichi; Di Benedetto, Fabrizio; Brustia, Raffaele; Valle, Raffaele Dalla; Boggi, Ugo; Geller, David; Belli, Andrea; Memeo, Riccardo; Gruttadauria, Salvatore; Mejia, Alejandro; Park, James O; Rotellar, Fernando; Choi, Gi-Hong; Robles-Campos, Ricardo; Wang, Xiaoying; Sutcliffe, Robert P; Schmelzle, Moritz; Pratschke, Johann; Tang, Chung-Ngai; Chong, Charing C N; Lee, Kit-Fai; Meurs, Juul; D'Hondt, Mathieu; Monden, Kazuteru; Lopez-Ben, Santiago; Kingham, T Peter; Ferrero, Alessandro; Ettorre, Giuseppe Maria; Sandri, Giovanni Battista Levi; Saleh, Mansour; Cherqui, Daniel; Zheng, Junhao; Liang, Xiao; Mazzotta, Alessandro; Soubrane, Olivier; Wakabayashi, Go; Troisi, Roberto I; Cheung, Tan-To; Kato, Yutaro; Sugioka, Atsushi; D'Silva, Mizelle; Han, Ho-Seong; Nghia, Phan Phuoc; Long, Tran Cong Duy; Edwin, Bjørn; Fuks, David; Chen, Kuo-Hsin; Hilal, Mohammad Abu; Aldrighetti, Luca; Liu, Rong; Goh, Brian K P. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - Publish Ahead of Print:(2023). [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
Vivarelli, Marco;
2023-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
