• Annals of surgery · Dec 2023

    Multicenter Study

    Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.

    • Qu Liu, Wanguang Zhang, Joseph J Zhao, Nicholas L Syn, Federica Cipriani, Mohammad Alzoubi, Davit L Aghayan, Tiing-Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Dalla ValleBernardoBDepartment of Surgery, Dentistry, Gynecology and Pediatrics, General and Hepatobiliary Surgery, University of Verona, GB Rossi Hospital, Verona, Italy., Andrea Ruzzenente, Chee-Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Moritz Schmelzle, Johann Pratschke, Chung-Ngai Tang, Charing C N Chong, Kit-Fai Lee, Juul Meurs, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Thomas Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Mansour Saleh, Daniel Cherqui, Junhao Zheng, Xiao Liang, Alessandro Mazzotta, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Mizelle D'Silva, Ho-Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Bjørn Edwin, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Rong Liu, GohBrian K PBKPDepartment of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore.Duke National University of Singapore Medical School, Singapore., and International robotic and laparoscopic liver resection study group investigators.
    • The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
    • Ann. Surg. 2023 Dec 1; 278 (6): 969975969-975.

    ObjectiveTo compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH).BackgroundRobotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH.MethodsThis 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.ResultsA 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].ConclusionsThis 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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