An international multicenter propensity-score matched and coarsened-exact matched analysis comparing robotic versus laparoscopic partial liver resections of the anterolateral segments.
anterolateral segment
laparoscopic liver resection
minimally invasive liver surgery
robotic liver resection
Journal
Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Titre abrégé: J Hepatobiliary Pancreat Sci
Pays: Japan
ID NLM: 101528587
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
revised:
23
01
2022
received:
24
11
2021
accepted:
15
02
2022
pubmed:
9
4
2022
medline:
31
8
2022
entrez:
8
4
2022
Statut:
ppublish
Résumé
Robotic liver resections (RLR) may have the ability to address some of the drawbacks of laparoscopic liver resections (LLR) but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques. A retrospective study was conducted of 3202 patients who underwent minimally invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. Two thousand six hundred and six cases met study criteria of which there were 358 RLR and 1868 LLR cases. Perioperative outcomes were compared between the two groups using a 1:3 Propensity Score Matched (PSM) and 1:1 Coarsened Exact Matched (CEM) analysis. Patients matched after 1:3 PSM (261 RLR vs 783 LLR) and 1:1 CEM (296 RLR vs 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality, and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss (50 mL vs 100 ml, P < .001) and lower rates of open conversion on both PSM (1.5% vs 6.8%, P = .003) and CEM (1.4% vs 6.4%, P = .004) compared to LLR. Though PSM analysis showed RLR to have a longer operating time than LLR (170 minutes vs 160 minutes, P = .036), this difference proved to be insignificant on CEM (167 minutes vs 163 minutes, P = .575). This multicentre international combined PSM and CEM study showed that both RLR and LLR have equivalent perioperative outcomes when performed in selected patients at high-volume centres. The robotic approach was associated with significantly lower blood loss and allowed more surgeries to be completed in a minimally invasive fashion.
Sections du résumé
BACKGROUND
BACKGROUND
Robotic liver resections (RLR) may have the ability to address some of the drawbacks of laparoscopic liver resections (LLR) but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques.
METHODS
METHODS
A retrospective study was conducted of 3202 patients who underwent minimally invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. Two thousand six hundred and six cases met study criteria of which there were 358 RLR and 1868 LLR cases. Perioperative outcomes were compared between the two groups using a 1:3 Propensity Score Matched (PSM) and 1:1 Coarsened Exact Matched (CEM) analysis.
RESULTS
RESULTS
Patients matched after 1:3 PSM (261 RLR vs 783 LLR) and 1:1 CEM (296 RLR vs 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality, and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss (50 mL vs 100 ml, P < .001) and lower rates of open conversion on both PSM (1.5% vs 6.8%, P = .003) and CEM (1.4% vs 6.4%, P = .004) compared to LLR. Though PSM analysis showed RLR to have a longer operating time than LLR (170 minutes vs 160 minutes, P = .036), this difference proved to be insignificant on CEM (167 minutes vs 163 minutes, P = .575).
CONCLUSION
CONCLUSIONS
This multicentre international combined PSM and CEM study showed that both RLR and LLR have equivalent perioperative outcomes when performed in selected patients at high-volume centres. The robotic approach was associated with significantly lower blood loss and allowed more surgeries to be completed in a minimally invasive fashion.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
843-854Investigateurs
Chung-Yip Chan
(CY)
Mikel Prieto
(M)
Henri Schotte
(H)
Celine De Meyere
(C)
Eric Lai
(E)
Felix Krenzien
(F)
Moritz Schmelzle
(M)
Roberto Montalti
(R)
Qu Liu
(Q)
Kit-Fai Lee
(KF)
Diana Salimgereeva
(D)
Ruslan Alikhanov
(R)
Lip-Seng Lee
(LS)
Jae Young Jang
(JY)
Chetana Lim
(C)
Kevin P Labadie
(KP)
Victor Lopez-Lopez
(V)
Informations de copyright
© 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Références
Hilal MA, van der Poel MJ, Samim M, Besselink MGH, Flowers D, Stedman B, et al. Laparoscopic liver resection for lesions adjacent to major vasculature: feasibility, safety and oncological efficiency. J Gastrointest Surg. 2015;19(4):692-8.
Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of benign liver lesions. Obstet Gynecol. 1991;78(5 Pt 2):956-8.
Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I, et al. The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg. 2009;250(5):825-30.
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261(4):619-29.
Croome KP, Yamashita MH. Laparoscopic vs open hepatic resection for benign and malignant tumors: an updated meta-analysis. Arch Surg. 2010;145(11):1109-18.
Nguyen KT, Geller DA. Outcomes of laparoscopic hepatic resection for colorectal cancer metastases. J Surg Oncol. 2010;102(8):975-7.
Sucandy I, Giovannetti A. Advantages of robotic over laparoscopic liver surgery-lesson learned from a high-volume medical center. Laparoscopic. Surgery. 2019;3:31.
Gavriilidis P, Roberts KJ, Aldrighetti L, Sutcliffe RP. A comparison between robotic, laparoscopic and open hepatectomy: a systematic review and network meta-analysis. Eur J Surg Oncol. 2020;46(7):1214-24.
Kim JK, Park JS, Han DH, Choi GH, Kim KS, Choi JS, et al. Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc. 2016;30(11):4756-64.
Montalti R, Scuderi V, Patriti A, Vivarelli M, Troisi RI. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc. 2016;30(3):1004-13.
Salloum C, Lim C, Lahat E, Gavara CG, Levesque E, Compagnon P, et al. Robotic-assisted versus laparoscopic left lateral Sectionectomy: analysis of surgical outcomes and costs by a propensity score matched cohort study. World J Surg. 2017;41(2):516-24.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, et al. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014;21(10):745-53.
Blackwell M, Iacus S, King G, Porro G. Cem: coarsened exact matching in Stata. The Stata Journal. 2009;9(4):524-46.
Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342(25):1878-86.
Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, et al. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg. 2018;267(2):199-207.
Syn N, Kabir T, Koh YX, Tan HL, Wang LZ, Chin BZ, et al. Survival advnatage of laparoscopic versus open resection for colorectal liver metastases: a meta-analysis of individual patient data from randomized trials and propensity-score matched studies. Ann Surg. 2020;272:253-65.
Beard RE, Tsung A. Minimally invasive approaches for surgical Management of Primary Liver Cancers. Cancer Control. 2017;24(3):1073274817729234.
Goh BKP, Lee SY, Koh YX, Kam JH, Chan CY. Minimally invasive major hepatectomies: a southeast Asian single institution contemporary experience with its first 120 consecutive cases. ANZ J Surg. 2020;90(4):553-7.
Beard RE, Khan S, Troisi RI, Montalti R, Vanlander A, Fong Y, et al. Long-term and oncologic outcomes of robotic versus laparoscopic liver resection for metastatic colorectal cancer: a multicenter, propensity score matching analysis. World J Surg. 2020;44(3):887-95.
Cipriani F, Fiorentini G, Magistri P, Fontani A, Menonna F, Annecchiarico M, et al. Pure laparoscopic versus robotic liver resections: multicentric propensity score based analysis with stratification according to difficulty scores. J Hepatobiliary Pancreat Sci. 2021;Online ahead of print.
Chong CCN, Lok HT, Fung AKY, Fong AKW, Cheung YS, Wong J, et al. Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system. Surg Endosc. 2020;34(5):2000-6.
Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg. 2014;259(3):549-55.
Packiam V, Bartlett DL, Tohme S, Reddy S, Marsh JW, Geller DA, et al. Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg. 2012;16(12):2233-8.
Goh BKP, Lee LS, Lee SY, Chow PKH, Chan CY, Chiow AKH. Initial experience with robotic hepatectomy in Singapore: analysis of 48 resections in 43 consecutive patients. ANZ J Surg. 2019;89(3):201-5.
Hallet J, Tsang M, Cheng ES, Habashi R, Kulyk I, Hanna SS, et al. The impact of perioperative red blood cell transfusions on long-term outcomes after hepatectomy for colorectal liver metastases. Ann Surg Oncol. 2015;22(12):4038-45.
Croner RS, Perrakis A, Hohenberger W, Brunner M. Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg. 2016;401(5):707-14.
Chiow AK, Fuks D, Choi GH, Syn N, Sucandy I, Marino MV, et al. International multicentre propensity-score matched analysis comparing robotic versus laparoscopic right posterior sectionectomy. Br J Surg. 2021;108(12):1513-1520.
Aziz H, Hanna K, Lashkari N, Ahmad NU, Genyk Y, Sheikh MR. Hospitalization costs and outcomes of open, laparoscopic, and robotic liver resections. Am Surg. 2021;31348211011064.
Wells AR, Hamar B, Bradley C, Gandy WM, Harrison PL, Sidney JA, et al. Exploring robust methods for evaluating treatment and comparison groups in chronic care management programs. Popul Health Manag. 2013;16(1):35-45.