Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases

被引：23

作者：

Liu, Qu ^{[1
,2
]}

Zhang, Wanguang ^{[3
,4
]}

Zhao, Joseph J. ^{[5
]}

Syn, Nicholas L. ^{[5
]}

Cipriani, Federica ^{[6
]}

Alzoubi, Mohammad ^{[7
]}

Aghayan, Davit L. ^{[8
,9
]}

Siow, Tiing-Foong ^{[10
]}

Lim, Chetana ^{[11
]}

Scatton, Olivier ^{[11
]}

Herman, Paulo ^{[12
]}

Coelho, Fabricio Ferreira ^{[12
]}

Marino, Marco, V ^{[13
,14
]}

Mazzaferro, Vincenzo ^{[15
,16
]}

Chiow, Adrian K. H. ^{[17
]}

Sucandy, Iswanto ^{[18
]}

Ivanecz, Arpad ^{[19
]}

Choi, Sung-Hoon ^{[20
]}

Lee, Jae Hoon ^{[21
]}

Prieto, Mikel ^{[22
]}

Vivarelli, Marco ^{[23
]}

Giuliante, Felice ^{[24
]}

Dalla Valle, Bernardo ^{[25
]}

Ruzzenente, Andrea ^{[25
]}

Yong, Chee-Chien ^{[26
]}

Chen, Zewei ^{[27
]}

Yin, Mengqiu ^{[27
]}

Fondevila, Constantino ^{[28
,29
]}

Efanov, Mikhail ^{[30
]}

Morise, Zenichi ^{[31
]}

Di Benedetto, Fabrizio ^{[32
]}

Brustia, Raffaele ^{[33
]}

Dalla Valle, Raffaele ^{[34
]}

Boggi, Ugo ^{[35
]}

Geller, David ^{[36
]}

Belli, Andrea ^{[37
]}

Memeo, Riccardo ^{[38
]}

Gruttadauria, Salvatore ^{[39
,40
]}

Mejia, Alejandro ^{[41
]}

Park, James O. ^{[42
]}

Rotellar, Fernando ^{[43
,44
]}

Choi, Gi-Hong ^{[45
]}

Robles-Campos, Ricardo ^{[46
]}

Wang, Xiaoying ^{[47
]}

Sutcliffe, Robert P. ^{[48
]}

Schmelzle, Moritz ^{[49
,50
,51
,52
]}

Pratschke, Johann ^{[49
,50
,51
,52
]}

Tang, Chung-Ngai ^{[53
]}

Chong, Charing C. N. ^{[54
]}

Lee, Kit-Fai ^{[54
]}

机构：

[1] Chinese Peoples Liberat Army PLA Gen Hosp, Med Ctr 1, Beijing, Peoples R China

[2] Chinese Peoples Liberat Army PLA Gen Hosp, Med Ctr 3, Organ Transplantat Dept, Beijing, Peoples R China

[3] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Hepat Surg Ctr, Wuhan, Peoples R China

[4] Huazhong Univ Sci & Technol, Tongji Med Coll, Tongji Hosp, Hubei Key Lab Hepatobiliary Pancreat Dis, Wuhan, Peoples R China

[5] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore

[6] IRCCS San Raffaele Hosp, Hepatobiliary Surg Div, Milan, Italy

[7] Fdn Poliambulanza, Dept Surg, Brescia, Italy

[8] Univ Oslo, Intervent Ctr, Oslo Univ Hosp, Inst Clin Med, Oslo, Norway

[9] Univ Oslo, Oslo Univ Hosp, Inst Clin Med, Dept HPB Surg, Oslo, Norway

[10] Far Eastern Mem Hosp, Dept Surg, Div Gen Surg, New Taipei, Taiwan

[11] Sorbonne Univ, Dept Digest HBP & Liver Transplantat, Hop Pitie Salpetriere, Paris, France

[12] Univ Sao Paulo, Dept Gastroenterol, Liver Surg Unit, Sch Med, Sao Paulo, Brazil

[13] Azienda Osped Osped Riuniti Villa Sofia Cervello, Gen Surg Dept, Palermo, Italy

[14] F Tappeiner Hosp, Gen Surg Dept, Merano, Italy

[15] Fdn IRCCS Ist Nazl Tumori Milano, HPB Surg & Liver Transplantat, Milan, Italy

[16] Univ Milan, Milan, Italy

[17] Changi Gen Hosp, Dept Surg, Hepatopancreatobiliary Unit, Singapore, Singapore

[18] AdventHlth Tampa, Digest Hlth Inst, Tampa, FL USA

[19] Univ Med Ctr Maribor, Dept Abdominal & Gen Surg, Maribor, Slovenia

[20] CHA Univ, CHA Bundang Med Ctr, Dept Gen Surg, Sch Med, Pocheon Si, South Korea

[21] Univ Ulsan, Asan Med Ctr, Dept Surg, Div Hepatobiliary & Pancreat Surg,Coll Med, Seoul, South Korea

[22] Univ Basque Country, Cruces Univ Hosp, Biocruces Bizkaia Hlth Res Inst, Hepatobiliary Surg & Liver Transplantat Unit, Bilbao, Spain

[23] Polytech Univ Marche, United Hosp Ancona, Dept Expt & Clin Med, HPB Surg & Transplantat Unit, Ancona, Italy

[24] Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli, Hepatobiliary Surg Unit, IRCCS, Rome, Italy

[25] Univ Verona, GB Rossi Hosp, Dept Surg Dent Gynecol & Pediat, Gen & Hepatobiliary Surg, Verona, Italy

[26] Chang Gung Mem Hosp, Dept Surg, Kaohsiung, Taiwan

[27] Zhejiang Univ, Affiliated Jinhua Hosp, Dept Hepatobiliary Surg, Sch Med, Jinhua, Zhejiang, Peoples R China

[28] Univ Barcelona, Gen & Digest Surg, Hosp Clin, IDIBAPS CIBERehd, Barcelona, Spain

[29] Hosp Univ La Paz, CIBERehd, IdiPAZ, Gen & Digest Surg, Madrid, Spain

[30] Moscow Clin Sci Ctr, Dept Hepatopancreatobiliary Surg, Moscow, Russia

[31] Fujita Hlth Univ, Okazaki Med Ctr, Dept Surg, Sch Med, Okazaki, Aichi, Japan

[32] Univ Modena & Reggio Emilia, HPB Surg & Liver Transplant Unit, Modena, Italy

[33] Henri Mondor Hosp, AP HP, Dept Digest & Hepatobiliary & Pancreat Surg, Creteil, France

[34] Univ Parma, Dept Med & Surg, Hepatobiliary Surg Unit, Parma, Italy

[35] Univ Pisa, Div Gen & Transplant Surg, Pisa, Italy

[36] Univ Pittsburgh, Dept Surg, Div Hepatobiliary & Pancreat Surg, Med Ctr, Pittsburgh, PA USA

[37] Natl Canc Ctr IRCCS G Pascale, Dept Abdominal Oncol, Div Hepatopancreatobiliary Surg Oncol, Naples, Italy

[38] F Miulli Gen Reg Hosp, Unit Hepatopancreatc Biliary Surg, Bari, Italy

[39] Univ Pittsburgh Med Ctr Italy, Ist Ricovero & Cura Carattere Sci Ist Mediterrane, Dept Treatment & Study Abdominal Dis & Abdominal, Palermo, Italy

[40] Univ Catania, Dept Gen Surg & Med Surg Specialties, Catania, Italy

[41] Methodist Dallas Med Ctr, Liver Inst, Dallas, TX USA

[42] Univ Washington, Dept Surg, Med Ctr, Seattle, WA USA

[43] Univ Navarra, Clin Univ Navarra, HPB & Liver Transplant Unit, Dept Gen Surg, Pamplona, Spain

[44] Inst Hlth Res Navarra IdisNA, Pamplona, Spain

[45] Yonsei Univ, Severance Hosp, Dept Surg, Div Hepatopancreatobiliary Surg,Coll Med, Seoul, South Korea

[46] Clin & Univ Hosp Virgen de la Arrixaca, Dept Gen Visceral & Transplantat Surg, IMIB ARRIXACA, Murcia, Spain

[47] Fudan Univ, Zhongshan Hosp, Liver Canc Inst, Dept Liver Surg & Transplantat, Shanghai, Peoples R China

[48] Univ Hosp Birmingham NHS Fdn Trust, Dept Hepatopancreatobiliary & Liver Transplant Su, Birmingham, W Midlands, England

[49] Charite, Campus Charite Mitte, Dept Surg, Berlin, Germany

[50] Charite, Campus Virchow Klinikum, Berlin, Germany

来源：

ANNALS OF SURGERY | 2023年 / 278卷 / 06期

关键词：

laparoscopic liver resection; extended right hepatectomy; major hepatectomy; right hepatectomy; robotic liver resection; OPEN LIVER RESECTION; HEPATOCELLULAR-CARCINOMA; LEARNING-CURVES; SURGERY; CIRRHOSIS; PROPOSAL; DIFFICULTY;

D O I：

10.1097/SLA.0000000000005855

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

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 1:1 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 1:1 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 {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 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.

引用

页码：969 / 975

页数：7

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