Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments: An International Multi-Center Study.

Journal

Annals of surgery

ISSN: 1528-1140

Titre abrégé: Ann Surg

Pays: United States

ID NLM: 0372354

Informations de publication

Date de publication:
24 Jul 2023

Historique:

medline: 24 7 2023

pubmed: 24 7 2023

entrez: 24 7 2023

Statut: aheadofprint

Résumé

To compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments. Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in existing literature. This is a post hoc analysis of a multicenter database of 5,446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumour features and perioperative characteristics were collected and analysed. Propensity score matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias. A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%) and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate (10 of 449 [2.2%] vs. 54 of 898 [6.0%]; P=0.002), less blood loss (100 mL [IQR; 50-200] days vs. 150 mL [IQR; 50-350]; P<0.001) and a shorter operative time (188 min [IQR; 140-270] vs. 222 min [IQR; 158-300]; P<0.001). These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis - lower open conversion rate (1 of 136 [0.7%] vs. 17 of 272 [6.2%]; P=0.009), less blood loss (100 mL [IQR; 48-200] vs. 160 mL [IQR; 50-400]; P<0.001) and shorter operative time (190 min [IQR; 141-258] vs. 230 min [IQR; 160-312]; P=0.003). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset. RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss and open conversion rate when compared to LLLR.

Sections du résumé

OBJECTIVE OBJECTIVE

To compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.

BACKGROUND BACKGROUND

Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in existing literature.

METHODS METHODS

This is a post hoc analysis of a multicenter database of 5,446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumour features and perioperative characteristics were collected and analysed. Propensity score matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.

RESULTS RESULTS

A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%) and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate (10 of 449 [2.2%] vs. 54 of 898 [6.0%]; P=0.002), less blood loss (100 mL [IQR; 50-200] days vs. 150 mL [IQR; 50-350]; P<0.001) and a shorter operative time (188 min [IQR; 140-270] vs. 222 min [IQR; 158-300]; P<0.001). These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis - lower open conversion rate (1 of 136 [0.7%] vs. 17 of 272 [6.2%]; P=0.009), less blood loss (100 mL [IQR; 48-200] vs. 160 mL [IQR; 50-400]; P<0.001) and shorter operative time (190 min [IQR; 141-258] vs. 230 min [IQR; 160-312]; P=0.003). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.

CONCLUSION CONCLUSIONS

RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss and open conversion rate when compared to LLLR.

Identifiants

DOI: 10.1097/SLA.0000000000006027 PMID: 37485989

pubmed: 37485989

doi: 10.1097/SLA.0000000000006027

pii: 00000658-990000000-00592

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

Nicholas L Syn (NL)

Mikel Prieto (M)

Celine De Meyere (C)

Kelvin K Ng (KK)

Diana Salimgereeva (D)

Ruslan Alikhanov (R)

Nita Thiruchelvam (N)

Jae Young Jang (JY)

Masayuki Kojima (M)

Jaime Arthur Pirola Kruger (JAP)

Victor Lopez-Lopez (V)

Margarida Casellas I Robert (MCI)

Roberto Montalti (R)

Mariano Giglio (M)

Boram Lee (B)

Hao-Ping Wang (HP)

Mansour Salleh (M)

Shian Yu (S)

Simone Vani (S)

Francesco Ardito (F)

Ugo Giustizieri (U)

Davide Citterio (D)

Federico Mocchegiani (F)

Marco Colasanti (M)

Giammauro Berardi (G)

Yoelimar Guzmán (Y)

Kevin P Labadie (KP)

Maria Conticchio (M)

Epameinondas Dogeas (E)

Emanuele F Kauffmann (EF)

Mario Giuffrida (M)

Daniele Sommacale (D)

Boris Amory (B)

Paolo Magistri (P)

Kohei Mishima (K)

Prashant Kadam (P)

Eric C H Lai (ECH)

Jacob Ghotbi (J)

Fabio Forchino (F)

Alessandro Mazzotta (A)

Yoshikuni Kawaguchi (Y)

Francois Cauchy (F)

Elias Karam (E)

Marco Barbara (M)

Duilio Pagano (D)

Informations de copyright

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.