Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy

Chong, Charing C; Fuks, David; Lee, Kit-Fai; Zhao, Joseph J; Choi, Gi Hong; Sucandy, Iswanto; Chiow, Adrian K H; Marino, Marco V; Gastaca, Mikel; Wang, Xiaoying; Lee, Jae Hoon; Efanov, Mikhail; Kingham, T Peter; D'Hondt, Mathieu; Troisi, Roberto I; Choi, Sung-Hoon; Sutcliffe, Robert P; Chan, Chung-Yip; Lai, Eric C H; Park, James O; Di Benedetto, Fabrizio; Rotellar, Fernando; Sugioka, Atsushi; Coelho, Fabricio Ferreira; Ferrero, Alessandro; Long, Tran Cong Duy; Lim, Chetana; Scatton, Olivier; Liu, Qu; Schmelzle, Moritz; Pratschke, Johann; Cheung, Tan-To; Liu, Rong; Han, Ho-Seong; Tang, Chung Ngai; Goh, Brian K P

Affiliation

The Chinese University of Hong Kong; Universite Paris Descartes; National University of Singapore; Singapore General Hospital; Yonsei University College of Medicine; Digestive Health Institute; Changi General Hospital; P. Giaccone University Hospital; Cruces University Hospital; University of the Basque Country; Zhongshan Hospital; Fudan University; Asan Medical Center; University of Ulsan College of Medicine; Moscow Clinical Scientific Center; Memorial Sloan Kettering Cancer Center; Groeninge Hospital; Federico II University Hospital Naples; CHA Bundang Medical Center; CHA University School of Medicine; University Hospitals Birmingham NHS Foundation Trust; Duke-National University Singapore Medical School; Pamela Youde Nethersole Eastern Hospital; University of Washington Medical Center; University of Modena and Reggio Emilia; Clinica Universidad de Navarra; Universidad de Navarra; Institute of Health Research of Navarra; Fujita Health University School of Medicine; University of Sao Paulo School of Medicine; Ospedale Mauriziano Umberto I; University of Medicine and Pharmacy at Ho Chi Minh City; Sorbonne Université, Paris; Assistance Publique des Hopitaux de Paris; General Hospital, Beijing; Freie Universität Berlin; The University of Hong Kong; Seoul National University Bundang Hospital; Seoul National University College of Medicine

Other Contributors

Schotte, Henri
De Meyere, Celine
D'Silva, Mizelle
Krenzien, Felix
Kadam, Prashant
Montalti, Roberto
Giglio, Mariano
Salimgereeva, Diana
Alikhanov, Ruslan
Lee, Lip Seng

Show all

Publication date

2022-03-09

Subject

Gastroenterology
Surgery

Metadata

Show full item record

Abstract

Importance: Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH). Objective: To compare the outcomes of robotic vs laparoscopic RH/ERH. Design, setting, and participants: In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included. Interventions: Robotic vs laparoscopic RH/ERH. Main outcomes and measures: Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed. Results: Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46). Conclusion and relevance: Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.

Citation

Chong CC, Fuks D, Lee KF, Zhao JJ, Choi GH, Sucandy I, Chiow AKH, Marino MV, Gastaca M, Wang X, Lee JH, Efanov M, Kingham TP, D'Hondt M, Troisi RI, Choi SH, Sutcliffe RP, Chan CY, Lai ECH, Park JO, Di Benedetto F, Rotellar F, Sugioka A, Coelho FF, Ferrero A, Long TCD, Lim C, Scatton O, Liu Q, Schmelzle M, Pratschke J, Cheung TT, Liu R, Han HS, Tang CN, Goh BKP; International Robotic and Laparoscopic Liver Resection study group investigators. Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy. JAMA Surg. 2022 May 1;157(5):436-444. doi: 10.1001/jamasurg.2022.0161.

Type

Article