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. 2022 May 1;157(5):436-444.
doi: 10.1001/jamasurg.2022.0161.

Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy

Charing C Chong  1 , David Fuks  2 , Kit-Fai Lee  1 , Joseph J Zhao  3 , Gi Hong Choi  4 , Iswanto Sucandy  5 , Adrian K H Chiow  6 , Marco V Marino  7 , Mikel Gastaca  8 , Xiaoying Wang  9 , Jae Hoon Lee  10 , Mikhail Efanov  11 , T Peter Kingham  12 , Mathieu D'Hondt  13 , Roberto I Troisi  14 , Sung-Hoon Choi  15 , Robert P Sutcliffe  16 , Chung-Yip Chan  17 , Eric C H Lai  18 , James O Park  19 , Fabrizio Di Benedetto  20 , Fernando Rotellar  21   22 , Atsushi Sugioka  23 , Fabricio Ferreira Coelho  24 , Alessandro Ferrero  25 , Tran Cong Duy Long  26 , Chetana Lim  27 , Olivier Scatton  27 , Qu Liu  28 , Moritz Schmelzle  29 , Johann Pratschke  29 , Tan-To Cheung  30 , Rong Liu  28 , Ho-Seong Han  31 , Chung Ngai Tang  18 , Brian K P Goh  17 ; International Robotic and Laparoscopic Liver Resection study group investigators
Collaborators, Affiliations

Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy

Charing C Chong et al. JAMA Surg. .

Abstract

Importance: Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH).

Objective: To compare the outcomes of robotic vs laparoscopic RH/ERH.

Design, setting, and participants: In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included.

Interventions: Robotic vs laparoscopic RH/ERH.

Main outcomes and measures: Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed.

Results: Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46).

Conclusion and relevance: Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Marino is a consultant for CAVA Robotics LLC. Dr Kingham reported personal fees from Olympus Surgical outside the submitted work. Dr Rotellar reported speaker fees and support from Sirtex Medical, Olympus Surgical, Baxter, Integra, Medtronic, and Corza Medical outside the submitted work. Dr Schmelzle reported personal fees from Merck Serono GmbH, Bayer AG, ERBE Elektromedizin GmbH, and Amgen and live surgery courses with Johnson & Johnson Medical, Takeda, Olympus Surgical, Medtronic, and Intuitive Surgical outside the submitted work. Dr Pratschke reports a research grant from Intuitive Surgical and personal fees or nonfinancial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas Pharma, CHG-Meridian, Chiesi Farmaceutici, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, Peterson, and Promedicis. Dr Goh reported honorarium from Ethicon and travel grants and honorarium from Johnson & Johnson and Transmedic Singapore during the conduct of the study. No other disclosures were reported.

Comment in

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