Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.

Qu Liu,Wanguang Zhang,Joseph J Zhao,Nicholas L Syn,Federica Cipriani,Mohammad Alzoubi,Davit L Aghayan,Tiing-Foong Siow,Chetana Lim,Olivier Scatton,Paulo Herman,Fabricio Ferreira Coelho,Marco V Marino,Vincenzo Mazzaferro,Adrian K H Chiow,Iswanto Sucandy,Arpad Ivanecz,Sung-Hoon Choi,Jae Hoon Lee,Mikel Prieto,Marco Vivarelli,Felice Giuliante, Bernardo Dalla Valle,Andrea Ruzzenente,Chee-Chien Yong,Zewei Chen,Mengqiu Yin,Constantino Fondevila,Mikhail Efanov,Zenichi Morise,Fabrizio Di Benedetto,Raffaele Brustia,Raffaele Dalla Valle,Ugo Boggi,David Geller,Andrea Belli,Riccardo Memeo,Salvatore Gruttadauria,Alejandro Mejia,James O Park,Fernando Rotellar,Gi-Hong Choi,Ricardo Robles-Campos,Xiaoying Wang,Robert P Sutcliffe,Moritz Schmelzle,Johann Pratschke,Chung-Ngai Tang,Charing C N Chong,Kit-Fai Lee, Juul Meurs,Mathieu D'Hondt,Kazuteru Monden,Santiago Lopez-Ben,Thomas Peter Kingham,Alessandro Ferrero,Giuseppe Maria Ettorre,Giovanni Battista Levi Sandri, Mansour Saleh,Daniel Cherqui,Junhao Zheng,Xiao Liang,Alessandro Mazzotta,Olivier Soubrane,Go Wakabayashi,Roberto I Troisi,Tan-To Cheung,Yutaro Kato,Atsushi Sugioka,Mizelle D'Silva,Ho-Seong Han, Phan Phuoc Nghia,Tran Cong Duy Long,Bjørn Edwin,David Fuks,Kuo-Hsin Chen,Mohammad Abu Hilal,Luca Aldrighetti,Rong Liu,Brian K P Goh

Annals of surgery（2023）

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摘要

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 R-MH is superior to 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. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were 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 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) 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 with L-MH. On subset analysis of 1273 patients with cirrhosis, 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]. CONCLUSIONS: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.

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