Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma.

Importance: Long-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far. Objective: To analyze short- and long-term outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique. Design, Setting, and Participants: This cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR. Main Outcomes and Measures: A retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P < .05 was considered significant. Results: The study included 398 patients (RLR group: 125 men, 33 women, median [IQR] age, 66 [58-71] years; OLR group: 315 men, 83 women; median [IQR] age, 70 [64-74] years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median [IQR], 295 [190-370] minutes vs 200 [165-255] minutes, including docking; P < .001) but a significantly shorter hospital length of stay (median [IQR], 4 [3-6] days vs 10 [7-13] days; P < .001) and a lower number of admissions to the intensive care unit (7 [6.6%] vs 21 [19.8%]; P = .002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 [7.5%] vs 30 [28.3%]; P = .001), with no cases of grade C failure. The 90-day overall survival rate was comparable between the 2 groups (RLR, 99.1% [95% CI, 93.5%-99.9%]; OLR, 97.1% [95% CI, 91.3%-99.1%]), as was the cumulative incidence of death related to tumor recurrence (RLR, 8.8% [95% CI, 3.1%-18.3%]; OLR, 10.2% [95% CI, 4.9%-17.7%]). Conclusions and Relevance: This study represents the largest Western experience to date of full RLR for HCC. Compared with OLR, RLR performed in tertiary centers represents a safe treatment strategy for patients with HCC and those with compromised liver function while achieving oncologic efficacy.

Effects of ozonation pretreatment on natural organic matter and wastewater derived organic matter - Possible implications on the formation of ozonation by-products.

The aim of this study was to investigate possible implications of natural and wastewater derived organic matter in river water that is subsequently used following treatment for drinking purposes. River water was subjected to lab-scale ozonation experiments under different ozone doses (0.1, 0.4, 0.8, 1.0 and 2.0 mgO3/mgC) and contact times (1, 3, 5, 8 and 10 min). Mixtures of river water with humic acids or wastewaters (sewage wastewater and secondary effluents) at different proportions were also ozonated. Dissolved organic carbon and biodegradable dissolved organic carbon concentrations as well as spectroscopic characteristics (UV absorbance and fluorescence intensities) of different types of dissolved organic matter and possible changes due to the ozonation treatment are presented. River water, humic substances and wastewater exhibited distinct spectroscopic characteristics that could serve for pollution source tracing. Wastewater impacted surface water results in higher formation of carbonyl compounds. However, the formation yield (µg/mgC) of wastewaters was lower than that of surface water possibly due to different composition of wastewater derived organic matter and the presence of scavengers, which may limit the oxidative efficiency of ozone.