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 R-MH is superior to 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. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were 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 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) 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 with L-MH. On subset analysis of 1273 patients with cirrhosis, 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]. Conclusions: 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.; Dalla Valle, B.; Ruzzenente, A.; Yong, C. -C.; Chen, Z.; Yin, M.; Fondevila, C.; Efanov, M.; Morise, Z.; Di Benedetto, F.; Brustia, R.; Dalla Valle, R.; 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.; D'Hondt, M.; Monden, K.; Lopez-Ben, S.; Kingham, T. P.; Ferrero, A.; Ettorre, G. M.; Levi Sandri, G. B.; Saleh, M.; Cherqui, D.; Zheng, J.; Liang, X.; Mazzotta, A.; Soubrane, O.; Wakabayashi, G.; Troisi, R. I.; Cheung, T. -T.; Kato, Y.; Sugioka, A.; D'Silva, M.; Han, H. -S.; Nghia, P. P.; Long, T. C. D.; Edwin, B.; Fuks, D.; Chen, K. -H.; Abu Hilal, M.; Aldrighetti, L.; Liu, R.; Goh, B. 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

Cipriani F.;Aldrighetti L.;
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 R-MH is superior to 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. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were 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 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) 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 with L-MH. On subset analysis of 1273 patients with cirrhosis, 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]. Conclusions: 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.
2023
extended right hepatectomy
laparoscopic liver resection
major hepatectomy
right hepatectomy
robotic liver resection
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/163577
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