Erschienen in:
23.08.2022 | Hepatobiliary Tumors
Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis
verfasst von:
Iswanto Sucandy, MD, FACS, Shlomi Rayman, MD, Eric C. Lai, MBChB, FRACS, Chung-Ngai Tang, MBBS, FRCS, Yvette Chong, MBBS, Mikhail Efanov, MD, PhD, David Fuks, MD, PhD, Gi-Hong Choi, MD, Charing C. Chong, MBChB, MSc, FRCS, Adrian K. H. Chiow, MBBS, MMed, FRCS, Marco V. Marino, MD, PhD, FACS, FEBS, Mikel Prieto, MD, Jae-Hoon Lee, MD, PhD, T. Peter Kingham, MD, Mathieu D’Hondt, MD, PhD, Roberto I. Troisi, MSc, MD, PhD, FEBS, Sung Hoon Choi, MD, Robert P. Sutcliffe, MD, FRCS, Tan-To Cheung, MBBS, FRCS, Fernando Rotellar, MD, PhD, James O. Park, MD, Olivier Scatton, MD, PhD, Ho-Seong Han, MD, PhD, Johann Pratschke, MD, Xiaoying Wang, MD, Rong Liu, MD, PhD, Brian K. P. Goh, MBBS, MSc, MMed, FRCS, International Robotic, Laparoscopic Liver Resection Study Group Investigators
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 13/2022
Einloggen, um Zugang zu erhalten
Abstract
Background
Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database.
Methods
An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade.
Results
Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009).
Conclusion
Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.