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.

doi:10.1097/SLA.0000000000005855

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]