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. - 278:6(2023), pp. 969-975. [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.| File | Dimensione | Formato | |
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Post-print.pdf
Open Access dal 16/04/2024
Descrizione: This is a non-final version of an article published in final form in Liu, Qu MD*,†; Zhang, Wanguang MD‡; Zhao, Joseph J. MBBS§; Syn, Nicholas L. MBBS§; Cipriani, Federica MD, PhD∥; Alzoubi, Mohammad MD¶; Aghayan, Davit L. MD, PhD#; Siow, Tiing-Foong MD**; Lim, Chetana MD, PhD††; Scatton, Olivier MD, PhD††; Herman, Paulo MD, PhD‡‡; Coelho, Fabricio Ferreira MD, PhD‡‡; Marino, Marco V. MD, PhD§§; Mazzaferro, Vincenzo MD, PhD∥∥; Chiow, Adrian K. H. MBBS, MMed¶¶; Sucandy, Iswanto MD##; Ivanecz, Arpad MD, PhD***; Choi, Sung-Hoon MD†††; Lee, Jae Hoon MD, PhD‡‡‡; Prieto, Mikel MD§§§; Vivarelli, Marco MD∥∥∥; Giuliante, Felice MD¶¶¶; Dalla Valle, Bernardo MD###; Ruzzenente, Andrea MD###; Yong, Chee-Chien MD****; Chen, Zewei MD††††; Yin, Mengqiu MD††††; Fondevila, Constantino MD‡‡‡‡; Efanov, Mikhail MD, PhD§§§§; Morise, Zenichi MD, PhD∥∥∥∥; Di Benedetto, Fabrizio MD, PhD¶¶¶¶; Brustia, Raffaele MD####; Dalla Valle, Raffaele MD*****; Boggi, Ugo MD, PhD†††††; Geller, David MD‡‡‡‡‡; Belli, Andrea MD, PhD§§§§§; Memeo, Riccardo MD∥∥∥∥∥; Gruttadauria, Salvatore MD¶¶¶¶¶; Mejia, Alejandro MD#####; Park, James O. MD******; Rotellar, Fernando MD, PhD††††††; Choi, Gi-Hong MD‡‡‡‡‡‡; Robles-Campos, Ricardo MD, PhD§§§§§§; Wang, Xiaoying MD, PhD∥∥∥∥∥∥; Sutcliffe, Robert P. MD¶¶¶¶¶¶; Schmelzle, Moritz MD######; Pratschke, Johann MD######; Tang, Chung-Ngai MBBS*******; Chong, Charing C. N. MBChB, MSc†††††††; Lee, Kit-Fai MBBS†††††††; Meurs, Juul MD‡‡‡‡‡‡‡; D’Hondt, Mathieu MD, PhD‡‡‡‡‡‡‡; Monden, Kazuteru MD§§§§§§§; Lopez-Ben, Santiago MD∥∥∥∥∥∥∥; Kingham, Thomas Peter MD¶¶¶¶¶¶¶; Ferrero, Alessandro MD#######; Ettorre, Giuseppe Maria MD********; Levi Sandri, Giovanni Battista MD, PhD********; Saleh, Mansour MD††††††††; Cherqui, Daniel MD††††††††; Zheng, Junhao MD‡‡‡‡‡‡‡‡; Liang, Xiao MD, PhD‡‡‡‡‡‡‡‡; Mazzotta, Alessandro MD§§§§§§§§; Soubrane, Olivier MD, PhD§§§§§§§§; Wakabayashi, Go MD, PhD∥∥∥∥∥∥∥∥; Troisi, Roberto I. MSc, MD, PhD¶¶¶¶¶¶¶¶; Cheung, Tan-To MS, MD########; Kato, Yutaro MD, PhD*********; Sugioka, Atsushi MD, PhD*********; D’Silva, Mizelle MD†††††††††; Han, Ho-Seong MD, PhD†††††††††; Nghia, Phan Phuoc MD‡‡‡‡‡‡‡‡‡; Long, Tran Cong duy MD, PhD‡‡‡‡‡‡‡‡‡; Edwin, Bjørn MD, PhD#; Fuks, David MD, PhD§§§§§§§§; Chen, Kuo-Hsin MD**; Abu Hilal, Mohammad MD, PhD§§§§§§§§§; Aldrighetti, Luca MD, PhD∥; Liu, Rong MD, PhD*; Goh, Brian K. P. MBBS, MMed, MSc∥∥∥∥∥∥∥∥∥,¶¶¶¶¶¶¶¶¶; International robotic and laparoscopic liver resection study group investigators. Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases. Annals of Surgery 278(6):p 969-975, December 2023. | DOI: 10.1097/SLA.0000000000005855. © 2023 Lippincott. Only personal use of this material is permitted. Permission from publisher must be obtained for all other uses, in any current or future media.
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