Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis
Kwak, Bong Jun Lee, Jae Hoon Chin, Ken Min Syn, Nicholas L Choi, Sung Hoon Cheung, Tan To Chiow, Adrian K H Sucandy, Iswanto Marino, Marco V Prieto, Mikel
Kwak, Bong Jun
Lee, Jae Hoon
Chin, Ken Min
Syn, Nicholas L
Choi, Sung Hoon
Cheung, Tan To
Chiow, Adrian K H
Sucandy, Iswanto
Marino, Marco V
Prieto, Mikel
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2023-04-17
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Abstract
Introduction: Minimally invasive liver resection (MILR) is widely recognized as a safe and beneficial procedure in the treatment of both malignant and benign liver diseases. Hepatolithiasis has traditionally been reported to be endemic only in East Asia, but has seen a worldwide uptrend in recent decades with increasingly frequent and invasive endoscopic instrumentation of the biliary tract for a myriad of conditions. To date, there has been a woeful lack of high-quality evidence comparing the laparoscopic (LLR) and robotic (RLR) approaches to treatment hepatolithiasis.
Methods: This is an international multicenter retrospective analysis of 273 patients who underwent RLR or LRR for hepatolithiasis at 33 centers in 2003-2020. The baseline clinicopathological characteristics and perioperative outcomes of these patients were assessed. To minimize selection bias, 1:1 (48 and 48 cases of RLR and LLR, respectively) and 1:2 (37 and 74 cases of RLR and LLR, respectively) propensity score matching (PSM) was performed.
Results: In the unmatched cohort, 63 (23.1%) patients underwent RLR, and 210 (76.9%) patients underwent LLR. Patient clinicopathological characteristics were comparable between the groups after PSM. After 1:1 and 1:2 PSM, RLR was associated with less blood loss (p = 0.003 in 1:2 PSM; p = 0.005 in 1:1 PSM), less patients with blood loss greater than 300 ml (p = 0.024 in 1:2 PSM; p = 0.027 in 1:1 PSM), and lower conversion rate to open surgery (p = 0.003 in 1:2 PSM; p < 0.001 in 1:1 PSM). There was no significant difference between RLR and LLR in use of the Pringle maneuver, median Pringle maneuver duration, 30-day readmission rate, postoperative morbidity, major morbidity, reoperation, and mortality.
Conclusion: Both RLR and LLR were safe and feasible for hepatolithiasis. RLR was associated with significantly less blood loss and lower open conversion rate.
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Kwak BJ, Lee JH, Chin KM, Syn NL, Choi SH, Cheung TT, Chiow AKH, Sucandy I, Marino MV, Prieto M, Chong CC, Choi GH, Efanov M, Kingham TP, Sutcliffe RP, Troisi RI, Pratschke J, Wang X, D'Hondt M, Tang CN, Mishima K, Wakabayashi G, Cherqui D, Aghayan DL, Edwin B, Scatton O, Sugioka A, Long TCD, Fondevila C, Alzoubi M, Hilal MA, Ruzzenente A, Ferrero A, Herman P, Lee B, Fuks D, Cipriani F, Liu Q, Aldrighetti L, Liu R, Han HS, Goh BKP; International robotic and laparoscopic liver resection study group investigators. Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis. Surg Endosc. 2023 Aug;37(8):5855-5864. doi: 10.1007/s00464-023-10051-8. Epub 2023 Apr 17. PMID: 37067594.
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