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Propensity Score-matched Analysis Comparing Robotic Versus Laparoscopic Minor Liver Resections of the Anterolateral Segments: an International Multi-center Study of 10,517 Cases

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机构: [1]Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai, China [2]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore [3]Ministry of Health Holdings Singapore, Singapore [4]Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France [5]Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France [6]Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT, University of Pittsburgh Medical Center Italy, Palermo,Italy Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico— Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy andꞏDepartment of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy [7]Department of Surgery, Fondazione Poliambulanza, Brescia, Italy [8]Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy [9]Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan [10]Department of Digestive, HBP and Liver Transplantation, Hopital Pitte-Salpetriere, Sorbonne Universite, Paris, France [11]Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil [12]The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway [13]General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy [14]Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany [15]HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy [16]Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore [17]AdventHealth Tampa, Digestive Health Institute, Tampa, Florida, USA [18]Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia [19]Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea [20]Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea [21]Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain [22]HPB Surgery and Transplantation Unit, United Hospital of Ancona, Department of Experimental and Clinical Medicine Polytechnic University of Marche, Ancona, Italy [23]Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy [24]General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics University of Verona, GB Rossi Hospital, Verona, Italy [25]Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung. [26]Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China [27]General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain and General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain [28]Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia [29]Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan [30]Hepatopancreatobiliary Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy [31]Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri- Mondor Hospital, Creteil, France [32]Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy [33]Division of General and Transplant Surgery, University of Pisa, Pisa, Italy [34]Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA [35]Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center – IRCCS-G. Pascale, Naples, Italy [36]Department of Hepato-Pancreatc-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, Bari, Italy and Department of Medicine and Surgery, LUM University, Casamassima, Bari, Italy [37]The Liver Institute, Methodist Dallas Medical Center, Dallas, Texas, USA [38]Department of Surgery, University of Washington Medical Center. Seattle, USA [39]HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain & Institute of Health Research of Navarra (IdisNA), Pamplona, Spain [40]Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea [41]Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain [42]Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo Japan [43]Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, The Netherlands [44]Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom [45]Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany [46]Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China [47]Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China [48]Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium [49]Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan [50]Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain [51]Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA [52]Dept of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany [53]Department of Abdominal Transplantation and Hepatobiliary Surgery, Columbia University, Irving Medical Center, New York, New York, USA, MedStar Georgetown Transplant Institute, PHC, Medstar Georgetown University Hospital, Washington, DC, USA and Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA [54]Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China [55]Department of General and Oncological Surgery. Mauriziano Hospital, Turin, Italy [56]Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy [57]Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France [58]Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China [59]Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan [60]Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy [61]Department of Surgical Science, Oncology and Gastroenterology (DiSCOG), Hepatobiliary pancreatic surgery and Liver Transplant Unit, Padua University Hospital, Padua, Italy [62]Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China [63]Department of Hepatobiliary and Pancreatic Surgery, National Cancer Hospital East, Chiba, Japan [64]Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea [65]Department of Hepatopancreatobiliary Surgery, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam [66]Department of Surgery, University Hospital Southampton, United Kingdom [67]Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China [68]Division of General Surgery, Far Eastern Memorial Hospital, New Taipei City [69]Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China [70]Surger Academic Clinical Programme, Duke National University of Singapore Medical School, Singapore, Singapore
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关键词: Propensity score-matching robotic liver resections laparoscopic liver resections minor liver resection anterolateral segments cirrhosis

摘要:
To compare the outcomes of robotic minor liver resections (RMLR) versus laparoscopic (L) MLR of the anterolateral segments.Robotic liver surgery has been gaining prominence over the years with increasing usage for a myriad of hepatic resections. Robotic liver resections(RLR) has demonstrated non-inferiority to laparoscopic(L)LR while illustrating advantages over conventional laparoscopy especially for technically difficult and major LR. However, the advantage of RMLR for the anterolateral(AL) (segments II, III, IVb, V and VI) segments, has not been clearly demonstrated.Between 2008 to 2022, 15,356 of 29,861 patients from 68 international centres underwent robotic(R) or laparoscopic minor liver resections (LMLR) for the AL segments Propensity score matching (PSM) analysis was performed for matched analysis.10,517 patients met the study criteria of which 1,481 underwent RMLR and 9,036 underwent LMLR. A PSM cohort of 1,401 patients in each group were identified for analysis. Compared to the LMLR cohort, the RMLR cohort demonstrated significantly lower median blood loss (75ml vs. 100ml, P<0.001), decreased blood transfusion (3.1% vs. 5.4%, P=0.003), lower incidence of major morbidity (2.5% vs. 4.6%, P=0.004), lower proportion of open conversion (1.2% vs. 4.5%, P<0.001), shorter post operative stay (4 days vs. 5 days, P<0.001), but higher rate of 30-day readmission (3.5% vs. 2.1%, P=0.042). These results were then validated by a 1:2 PSM analysis. In the subset analysis for 3,614 patients with cirrhosis, RMLR showed lower median blood loss, decreased blood transfusion, lower open conversion and shorter post operative stay than LMLR.RMLR demonstrated statistically significant advantages over LMLR even for resections in the AL segments although most of the observed clinical differences were minimal.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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大类 | 1 区 医学
小类 | 1 区 外科
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大类 | 1 区 医学
小类 | 1 区 外科
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第一作者机构: [1]Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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通讯机构: [2]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore [68]Division of General Surgery, Far Eastern Memorial Hospital, New Taipei City
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