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Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.
Liu, Qu; Zhang, Wanguang; Zhao, Joseph J; Syn, Nicholas L; Cipriani, Federica; Alzoubi, Mohammad; Aghayan, Davit L; Siow, Tiing-Foong; Lim, Chetana; Scatton, Olivier; Herman, Paulo; Coelho, Fabricio Ferreira; Marino, Marco V; Mazzaferro, Vincenzo; Chiow, Adrian K H; Sucandy, Iswanto; Ivanecz, Arpad; Choi, Sung-Hoon; Lee, Jae Hoon; Prieto, Mikel; Vivarelli, Marco; Giuliante, Felice; Dalla Valle, Bernardo; Ruzzenente, Andrea; Yong, Chee-Chien; Chen, Zewei; Yin, Mengqiu; Fondevila, Constantino; Efanov, Mikhail; Morise, Zenichi; Di Benedetto, Fabrizio; Brustia, Raffaele; Dalla Valle, Raffaele; Boggi, Ugo; Geller, David; Belli, Andrea; Memeo, Riccardo; Gruttadauria, Salvatore; Mejia, Alejandro; Park, James O; Rotellar, Fernando; Choi, Gi-Hong; Robles-Campos, Ricardo; Wang, Xiaoying; Sutcliffe, Robert P; Schmelzle, Moritz; Pratschke, Johann; Tang, Chung-Ngai; Chong, Charing C N; Lee, Kit-Fai.
Afiliación
  • Liu Q; The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
  • Zhang W; Organ Transplantation Department, The Third Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
  • Zhao JJ; Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
  • Syn NL; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Cipriani F; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Alzoubi M; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
  • Aghayan DL; Department of Surgery, Fondazione Poliambulanza, Brescia, Italy.
  • Siow TF; The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Lim C; Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
  • Scatton O; Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France.
  • Herman P; Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France.
  • Coelho FF; Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
  • Marino MV; Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
  • Mazzaferro V; General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy and General Surgery Department, F. Tappeiner Hospital, Merano, Italy.
  • Chiow AKH; HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy.
  • Sucandy I; Department of Surgery, Hepatopancreatobiliary Unit, Changi General Hospital, Singapore.
  • Ivanecz A; Digestive Health Institute, AdventHealth Tampa, Tampa, FL.
  • Choi SH; Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia.
  • Lee JH; Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
  • Prieto M; Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • Vivarelli M; Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain.
  • Giuliante F; Department of Experimental and Clinical Medicine, HPB Surgery and Transplantation Unit, United Hospital of Ancona, Polytechnic University of Marche, Ancona, Italy.
  • Dalla Valle B; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Ruzzenente A; Department of Surgery, Dentistry, Gynecology and Pediatrics, General and Hepatobiliary Surgery, University of Verona, GB Rossi Hospital, Verona, Italy.
  • Yong CC; Department of Surgery, Dentistry, Gynecology and Pediatrics, General and Hepatobiliary Surgery, University of Verona, GB Rossi Hospital, Verona, Italy.
  • Chen Z; Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
  • Yin M; Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
  • Fondevila C; Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
  • Efanov M; General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain and General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain.
  • Morise Z; Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia.
  • Di Benedetto F; Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan.
  • Brustia R; HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy.
  • Dalla Valle R; Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France.
  • Boggi U; Department of Medicine and Surgery, Hepatobiliary Surgery Unit, University of Parma, Parma, Italy.
  • Geller D; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
  • Belli A; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  • Memeo R; Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center-IRCCS-G. Pascale, Naples, Italy.
  • Gruttadauria S; Unit of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
  • Mejia A; Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy, Palermo, Italy and D
  • Park JO; The Liver Institute, Methodist Dallas Medical Center, Dallas, TX.
  • Rotellar F; Department of Surgery, University of Washington Medical Center. Seattle, WA.
  • Choi GH; Department of General Surgery, HPB and Liver Transplant Unit, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain and Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
  • Robles-Campos R; Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • Wang X; Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain.
  • Sutcliffe RP; Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
  • Schmelzle M; Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • Pratschke J; Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Tang CN; Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Chong CCN; Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
  • Lee KF; Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China.
Ann Surg ; 278(6): 969-975, 2023 12 01.
Article en En | MEDLINE | ID: mdl-37058429
ABSTRACT

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 11 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 11 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 {PSM200.0 [interquartile range (IQR)100.0, 450.0] vs 300.0 (IQR150.0, 500.0) mL; P = 0.012; CEM170.0 (IQR 90.0, 400.0) vs 200.0 (IQR100.0, 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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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Laparoscopía / Carcinoma Hepatocelular / Procedimientos Quirúrgicos Robotizados / Neoplasias Hepáticas Tipo de estudio: Clinical_trials Límite: Humans Idioma: En Año: 2023 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Laparoscopía / Carcinoma Hepatocelular / Procedimientos Quirúrgicos Robotizados / Neoplasias Hepáticas Tipo de estudio: Clinical_trials Límite: Humans Idioma: En Año: 2023 Tipo del documento: Article