A propensity score matched analysis of robotic and open hepatectomy for treatment of liver tumors. Clinical outcomes, oncological survival, and costs comparison.
Clinical outcomes
Minimally invasive hepatectomy
Oncological outcomes
Robotic hepatectomy
Robotic liver resection costs
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
24
05
2023
accepted:
04
07
2023
medline:
11
9
2023
pubmed:
10
7
2023
entrez:
10
7
2023
Statut:
ppublish
Résumé
Minimally invasive robotic hepatectomy is gaining popularity with a faster rate of adoption when compared to laparoscopic approach. Technical advantages brought by the robotic surgical system facilitate a transition from open to minimally invasive technique in hepatic surgery. Published matched data examining the results of robotic hepatectomy using the open approach as a benchmark are still limited. We aimed to compare the clinical outcomes, survival, and costs between robotic and open hepatectomy undertaken in our tertiary hepatobiliary center. With IRB approval, we prospectively followed 285 consecutive patients undergoing hepatectomy for neoplastic liver diseases between 2012 and 2020. Propensity score matched comparison of robotic and open hepatectomy was conducted by 1:1 ratio. Data are presented as median (mean ± SD). The matching process assigned 49 patients to each arm, open and robotic hepatectomy. There were no differences in R1 resection rates (4% vs 4%; p = 1.00). Differences in perioperative variables between open and robotic hepatectomy included postoperative complications (16% vs 2%; p = 0.02) and length of stay (LOS) [6 (7 ± 5.0) vs 4 (5 ± 4.0) days; p = 0.002]. There were no differences between open and robotic hepatectomy regarding postoperative hepatic insufficiency (10% vs 2%; p = 0.20). No difference was seen in long-term survival outcomes. While there were no differences in costs, robotic hepatectomy was associated with lower reimbursement [$20,432 (39,191 ± 41,467.81) vs $33,190 (67,860 ± 87,707.81); p = 0.04] and lower contribution margin [$-11,229 (3902 ± 42,572.43) vs $8768 (34,690 ± 89,759.56); p = 0.03]. Compared to open approach, robotic hepatectomy robotic offers lower rates of postoperative complications, shorter LOS and similar costs, while not compromising long-term oncological outcomes. Robotic hepatectomy may eventually become the preferred approach in minimally invasive treatment of liver tumors.
Identifiants
pubmed: 37428364
doi: 10.1007/s11701-023-01674-z
pii: 10.1007/s11701-023-01674-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2399-2407Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
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