Propensity-score matched and coarsened-exact matched analysis comparing robotic and laparoscopic major hepatectomies: an international multicenter study of 4822 cases.
Liu, Qu Zhang, Wanguang Zhao, Joseph J Syn, Nicholas L Cipriani, Federica Alzoubi, Mohammad Aghayan, Davit L Siow, Tiing-Foong Lim, Chetana Scatton, Olivier
Liu, Qu
Zhang, Wanguang
Zhao, Joseph J
Syn, Nicholas L
Cipriani, Federica
Alzoubi, Mohammad
Aghayan, Davit L
Siow, Tiing-Foong
Lim, Chetana
Scatton, Olivier
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2023-04-14
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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 robotic major hepatectomy (R-MH) is superior to laparoscopic major hepatectomy (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. 1:1 propensity score matched (PSM) and coarsened-exact matched (CEM) analysis was 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 [IQR:100.0, 450.0] ml vs. 300.0 [IQR:150.0, 500.0] ml; P=0.012; CEM:170.0 [IQR: 90.0, 400.0] ml 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 to L-MH. On subset analysis of 1273 cirrhotic patients, 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).
Conclusion: 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.
Citation
Liu Q, Zhang W, Zhao JJ, Syn NL, Cipriani F, Alzoubi M, Aghayan DL, Siow TF, Lim C, Scatton O, Herman P, Coelho FF, Marino MV, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Choi SH, Lee JH, Prieto M, Vivarelli M, Giuliante F, Valle BD, Ruzzenente A, Yong CC, Chen Z, Yin M, Fondevila C, Efanov M, Morise Z, Di Benedetto F, Brustia R, Valle RD, Boggi U, Geller D, Belli A, Memeo R, Gruttadauria S, Mejia A, Park JO, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Schmelzle M, Pratschke J, Tang CN, Chong CCN, Lee KF, Meurs J, D'Hondt M, Monden K, Lopez-Ben S, Kingham TP, Ferrero A, Ettorre GM, Sandri GBL, Saleh M, Cherqui D, Zheng J, Liang X, Mazzotta A, Soubrane O, Wakabayashi G, Troisi RI, Cheung TT, Kato Y, Sugioka A, D'Silva M, Han HS, Nghia PP, Long TCD, Edwin B, Fuks D, Chen KH, Hilal MA, Aldrighetti L, Liu R, Goh BKP; International robotic and laparoscopic liver resection study group investigators. Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases. Ann Surg. 2023 Apr 14. doi: 10.1097/SLA.0000000000005855. Epub ahead of print.
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Article