Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.
Ann Surg
; 278(6): 969-975, 2023 12 01.
Article
em 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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Base de dados:
MEDLINE
Assunto principal:
Laparoscopia
/
Carcinoma Hepatocelular
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Procedimentos Cirúrgicos Robóticos
/
Neoplasias Hepáticas
Tipo de estudo:
Clinical_trials
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article