Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments An International Multicenter Study

被引：21

作者：

Krenzien, Felix ^{[1
,2
,3
,4
]}

Schmelzle, Moritz ^{[1
,2
,3
,4
]}

Pratschke, Johann ^{[1
,2
,3
,4
]}

Feldbruegge, Linda ^{[1
,2
,3
,4
]}

Liu, Rong ^{[5
]}

Liu, Qu ^{[5
]}

Zhang, Wanguang ^{[6
,7
]}

Zhao, Joseph J. ^{[8
,9
]}

Tan, Hwee-Leong ^{[8
,9
]}

Cipriani, Federica ^{[10
]}

Hoogteijling, Tijs J. ^{[11
]}

Aghayan, Davit L. ^{[12
]}

Fretland, Asmund A. ^{[12
]}

Siow, Tiing Foong ^{[13
]}

Lim, Chetana ^{[14
]}

Scatton, Olivier ^{[14
]}

Herman, Paulo ^{[15
]}

Coelho, Fabricio F. ^{[15
]}

Marino, Marco V. ^{[16
,17
]}

Mazzaferro, Vincenzo ^{[18
,19
]}

Chiow, Adrian K. H. ^{[20
]}

Sucandy, Iswanto ^{[21
]}

Ivanecz, Arpad ^{[22
]}

Choi, Sung Hoon ^{[23
]}

Lee, Jae Hoon ^{[24
]}

Gastaca, Mikel ^{[25
]}

Vivarelli, Marco ^{[26
]}

Giuliante, Felice ^{[27
]}

Dalla Valle, Bernardo ^{[28
]}

Ruzzenente, Andrea ^{[28
]}

Yong, Chee-Chien ^{[29
]}

Chen, Zewei ^{[30
]}

Yin, Mengqiu ^{[30
]}

Fondevila, Constantino ^{[31
,32
]}

Efanov, Mikhail ^{[33
]}

Morise, Zenichi ^{[34
]}

Di Benedetto, Fabrizio ^{[35
]}

Brustia, Raffaele ^{[36
]}

Dalla Valle, Raffaele ^{[37
]}

Boggi, Ugo ^{[38
]}

Geller, David ^{[39
]}

Belli, Andrea ^{[40
]}

Memeo, Riccardo ^{[41
]}

Gruttadauria, Salvatore ^{[42
,43
]}

Mejia, Alejandro ^{[44
]}

Park, James O. ^{[45
]}

Rotellar, Fernando ^{[46
,47
]}

Choi, Gi-Hong ^{[48
]}

Robles-Campos, Ricardo ^{[49
]}

Wang, Xiaoying ^{[50
]}

机构：

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

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

[3] Free Univ Berlin, Berlin, Germany

[4] Berlin Inst Hlth, Berlin, Germany

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

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

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

[8] Singapore Gen Hosp, Dept Hepatopancreatobiliary & Transplant Surg, Singapore, Singapore

[9] Natl Canc Ctr Singapore, Singapore, Singapore

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

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

[12] Univ Oslo, Oslo Univ Hosp, Dept HPB Surg, Intervent Ctr,Inst Clin Med, Oslo, Norway

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

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

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

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

[17] P Giaccone Univ Hosp, Oncol Surg Dept, Palermo, Italy

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

[19] Univ Milan, Milan, Italy

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

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

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

[23] CHA Univ, Sch Med, CHA Bundang Med Ctr, Dept Gen Surg, Seongnam, South Korea

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

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

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

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

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

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

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

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

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

[33] Moscow Clin Sci Ctr, Dept Hepatopancreato Biliary Surg, Moscow, Russia

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

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

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

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

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

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

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

[41] F Miulli Gen Reg Hosp, Unit Hepatopancreatobiliary Surg, Bari, Italy

[42] Univ Pittsburgh Med Ctr Italy, Dept Treatment & Study Abdominal Dis & Abdominal, IRCCS, ISMETT, Palermo, Italy

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

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

[45] Univ Washington, Dept Surg, Med Ctr, Seattle, WA 98195 USA

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

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

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

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

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

来源：

ANNALS OF SURGERY | 2024年 / 279卷 / 02期

关键词：

laparoscopic liver resection; robotic liver resection; posterosuperior liver segments; liver cirrhosis; minimally-invasive hepatectomy; HEPATOCELLULAR-CARCINOMA; LESIONS; SURGERY; CIRRHOSIS; PROPOSAL;

D O I：

10.1097/SLA.0000000000006027

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: The purpose of this study was to compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.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 the existing literature.Methods: This is a post hoc analysis of a multicenter database of 5446 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, tumor features, and perioperative characteristics were collected and analyzed. Propensity score-matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.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]. Postoperative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.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 with LLLR.

引用

页码：297 / 305

页数：9

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