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

Q. Liu, W. Zhang, J. J. Zhao, N. L. Syn, Fabrizio Cipriani, M. Alzoubi, D. L. Aghayan, T. -F. Siow, C. Lim, O. Scatton, P. Herman, F. F. Coelho, M. V. Marino, V. Mazzaferro, A. K. H. Chiow, I. Sucandy, A. Ivanecz, S. -H. Choi, J. H. Lee, M. PrietoM. Vivarelli, Felice Giuliante, B. Dalla Valle, A. Ruzzenente, C. -C. Yong, Z. Chen, M. Yin, C. Fondevila, M. Efanov, Z. Morise, F. Di Benedetto, R. Brustia, R. Dalla Valle, U. Boggi, D. Geller, A. Belli, R. Memeo, S. Gruttadauria, A. Mejia, J. O. Park, F. Rotellar, G. -H. Choi, R. Robles-Campos, X. Wang, R. P. Sutcliffe, M. Schmelzle, J. Pratschke, C. -N. Tang, C. C. N. Chong, K. -F. Lee, J. Meurs, M. D'Hondt, K. Monden, S. Lopez-Ben, T. P. Kingham, A. Ferrero, G. M. Ettorre, G. B. Levi Sandri, M. Saleh, D. Cherqui, J. Zheng, X. Liang, Alessandro Dario Mazzotta, O. Soubrane, G. Wakabayashi, R. I. Troisi, T. -T. Cheung, Y. Kato, A. Sugioka, M. D'Silva, H. -S. Han, P. P. Nghia, T. C. D. Long, B. Edwin, D. Fuks, K. -H. Chen, M. Abu Hilal, L. Aldrighetti, R. Liu, B. K. P. Goh

Risultato della ricerca: Contributo in rivistaArticolo in rivista

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.
Lingua originaleEnglish
pagine (da-a)969-975
Numero di pagine7
RivistaAnnals of Surgery
Volume278
DOI
Stato di pubblicazionePubblicato - 2023

Keywords

  • extended right hepatectomy
  • laparoscopic liver resection
  • robotic liver resection
  • right hepatectomy
  • major hepatectomy

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