Comparison between minimally invasive right anterior and right posterior sectionectomy vs right hepatectomy: an International multicenter propensity score-matched and coarsened-exact-matched analysis of 1,100 patients.
Author
Willems, EdwardD'Hondt, Mathieu
Kingham, T Peter
Fuks, David
Choi, Gi-Hong
Syn, Nicholas L
Sucandy, Iswanto
Marino, Marco V
Prieto, Mikel
Chong, Charing C
Lee, Jae Hoon
Efanov, Mikhail
Chiow, Adrian K H
Choi, Sung Hoon
Sutcliffe, Robert P
Troisi, Roberto I
Pratschke, Johann
Cheung, Tan-To
Wang, Xiaoying
Tang, Chung-Ngai
Liu, Rong
Han, Ho-Seong
Goh, Brian K P
Publication date
2022-11-15
Metadata
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Background: The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy. Study design: This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact-matched analysis was performed. Results: A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching. Conclusions: Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.Citation
Willems E, D'Hondt M, Kingham TP, Fuks D, Choi GH, Syn NL, Sucandy I, Marino MV, Prieto M, Chong CC, Lee JH, Efanov M, Chiow AKH, Choi SH, Sutcliffe RP, Troisi RI, Pratschke J, Cheung TT, Wang X, Tang CN, Liu R, Han HS, Goh BKP; International Robotic and Laparoscopic Liver Resection Study Group Investigators. Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity Score-Matched and Coarsened-Exact-Matched Analysis of 1,100 Patients. J Am Coll Surg. 2022 Dec 1;235(6):859-868. doi: 10.1097/XCS.0000000000000394. Epub 2022 Nov 15.Type
ArticlePMID
36102506Publisher
Lippincott, Williams & Wilkinsae974a485f413a2113503eed53cd6c53
10.1097/XCS.0000000000000394