作者
Felix Krenzien,Moritz Schmelzle,Johann Pratschke,Linda Feldbrügge,Rong Liu,Qu Liu,Wanguang Zhang,Joseph J Zhao,Hwee Leong Tan,Francesco Cipriani,Tijs J. Hoogteijling,Davit L. Aghayan,Åsmund Avdem Fretland,Tiing-Foong Siow,Chetana Lim,Olivier Scatton,Paulo Herman,Fabrício Ferreira Coelho,Marco Vito Marino,Vincenzo Mazzaferro,Adrian Kah Heng Chiow,Iswanto Sucandy,Arpad Ivanecz,Sung Hoon Choi,Jae Hoon Lee,Mikel Gastaca,Marco Vivarelli,Felice Giuliante,Bernardo Dalla Valle,Andrea Ruzzenente,Chee‐Chien Yong,Zewei Chen,Mengqiu Yin,Constantino Fondevila,Михаил Ефанов,Zenichi Morise,Fabrizio Di Benedetto,Raffaele Brustia,Raffaele Dalla Valle,Ugo Boggi,David A. Geller,Andrea Belli,Riccardo Méméo,Salvatore Gruttadauria,Alejandro Mejía,James O. Park,Fernando Rotellar,Gi-Hong Choi,Ricardo Robles‐Campos,Xiaoying Wang,R. Sutcliffe,Kiyoshi Hasegawa,Chung‐Ngai Tang,Charing C.N. Chong,Kit‐Fai Lee,Juul Meurs,Mathieu D’Hondt,Kazuteru Monden,Santiago López‐Ben,T. Peter Kingham,Alessandro Ferrero,Giuseppe Maria Ettorre,Franco Pascual,Daniel Cherqui,Junhao Zheng,Xiao Liang,Olivier Soubrane,Go Wakabayashi,Roberto Troisi,Tan‐To Cheung,Yutaro Kato,Atsushi Sugioka,Safi Dokmak,Mizelle D’Silva,Ho‐Seong Han,Phan Phuoc Nghia,Tran Cong Duy Long,Mohammad Abu Hilal,Kuo‐Hsin Chen,David Fuks,Luca Aldrighetti,Bjørn Edwin,Brian K. P. Goh
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.