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 RMH 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, Q.; Zhang, W.; Zhao, J. J.; Syn, N. L.; Cipriani, F.; Alzoubi, M.; Aghayan, D. L.; Siow, T. -F.; Lim, C.; Scatton, O.; Herman, P.; Coelho, F. F.; Marino, M. V.; Mazzaferro, V.; Chiow, A. K. H.; Sucandy, I.; Ivanecz, A.; Choi, S. -H.; Lee, J. H.; Prieto, M.; Vivarelli, M.; Giuliante, F.; Valle, B. D.; Ruzzenente, A.; Yong, C. -C.; Chen, Z.; Yin, M.; Fondevila, C.; Efanov, M.; Morise, Z.; Di Benedetto, F.; Brustia, R.; Valle, R. D.; Boggi, U.; Geller, D.; Belli, A.; Memeo, R.; Gruttadauria, S.; Mejia, A.; Park, J. O.; Rotellar, F.; Choi, G. -H.; Robles-Campos, R.; Wang, X.; Sutcliffe, R. P.; Schmelzle, M.; Pratschke, J.; Tang, C. -N.; Chong, C. C. N.; Lee, K. -F.; Meurs, J.; Hondt, M. D.; Monden, K.; Lopez-Ben, S.; Kingham, T. P.; Ferrero, A.; Ettorre, G. M.; Sandri, G. B. L.; Saleh, M.; Cherqui, D.; Zheng, J.; Liang, X.; Mazzotta, A.; Soubrane, O.; Wakabayashi, G.; Troisi, R. I.; Cheung, T. -T.; Kato, Y.; Sugioka, A.; Silva, M. D.; Han, H. -S.; Nghia, P. P.; Long, T. C. D.; Edwin, B.; Fuks, D.; Chen, K. -H.; Hilal, M. A.; Aldrighetti, L.; Liu, R.; Goh, B. K. P.; Gastaca, M.; De Meyere, C.; Ng, K. K.; Salimgereeva, D.; Alikhanov, R.; Lee, L. -S.; Jang, J. Y.; Kojima, M.; Kruger, J. A. P.; Lopez-Lopez, V.; Robert, M. C. I.; Montalti, R.; Giglio, M.; Lee, B.; Wang, H. -P.; Pascual, F.; Yu, S.; Vani, S.; Ardito, F.; Giustizieri, U.; Citterio, D.; Mocchegiani, F.; Colasanti, M.; Guzman, Y.; Labadie, K. P.; Conticchio, M.; Dogeas, E.; Kauffmann, E. F.; Giuffrida, M.; Sommacale, D.; Laurent, A.; Magistri, P.; Mishima, K.; Krenzien, F.; Kadam, P.; Lai, E. C. H.; Ghotbi, J.; Fretland, A. A.; Forchino, F.. - 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
Montalti R.;Giglio M.;
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 RMH 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.
