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Multicenter Study
. 2023 Dec 1;278(6):969-975.
doi: 10.1097/SLA.0000000000005855. Epub 2023 Apr 14.

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

Qu Liu  1   2 , Wanguang Zhang  3 , Joseph J Zhao  4 , Nicholas L Syn  4 , Federica Cipriani  5 , Mohammad Alzoubi  6 , Davit L Aghayan  7 , Tiing-Foong Siow  8 , Chetana Lim  9 , Olivier Scatton  9 , Paulo Herman  10 , Fabricio Ferreira Coelho  10 , Marco V Marino  11 , Vincenzo Mazzaferro  12 , Adrian K H Chiow  13 , Iswanto Sucandy  14 , Arpad Ivanecz  15 , Sung-Hoon Choi  16 , Jae Hoon Lee  17 , Mikel Prieto  18 , Marco Vivarelli  19 , Felice Giuliante  20 , Bernardo Dalla Valle  21 , Andrea Ruzzenente  21 , Chee-Chien Yong  22 , Zewei Chen  23 , Mengqiu Yin  23 , Constantino Fondevila  24 , Mikhail Efanov  25 , Zenichi Morise  26 , Fabrizio Di Benedetto  27 , Raffaele Brustia  28 , Raffaele Dalla Valle  29 , Ugo Boggi  30 , David Geller  31 , Andrea Belli  32 , Riccardo Memeo  33 , Salvatore Gruttadauria  34 , Alejandro Mejia  35 , James O Park  36 , Fernando Rotellar  37 , Gi-Hong Choi  38 , Ricardo Robles-Campos  39 , Xiaoying Wang  40 , Robert P Sutcliffe  41 , Moritz Schmelzle  42 , Johann Pratschke  42 , Chung-Ngai Tang  43 , Charing C N Chong  44 , Kit-Fai Lee  44 , Juul Meurs  45 , Mathieu D'Hondt  45 , Kazuteru Monden  46 , Santiago Lopez-Ben  47 , Thomas Peter Kingham  48 , Alessandro Ferrero  49 , Giuseppe Maria Ettorre  50 , Giovanni Battista Levi Sandri  50 , Mansour Saleh  51 , Daniel Cherqui  51 , Junhao Zheng  52 , Xiao Liang  52 , Alessandro Mazzotta  53 , Olivier Soubrane  53 , Go Wakabayashi  54 , Roberto I Troisi  55 , Tan-To Cheung  56 , Yutaro Kato  57 , Atsushi Sugioka  57 , Mizelle D'Silva  58 , Ho-Seong Han  58 , Phan Phuoc Nghia  59 , Tran Cong Duy Long  59 , Bjørn Edwin  7 , David Fuks  53 , Kuo-Hsin Chen  8 , Mohammad Abu Hilal  60 , Luca Aldrighetti  5 , Rong Liu  1 , Brian K P Goh  61   62 ; International robotic and laparoscopic liver resection study group investigators
Collaborators, Affiliations
Free article
Multicenter Study

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

Qu Liu et al. Ann Surg. .
Free article

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 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.

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Conflict of interest statement

B.K.P.G. has received travel grants and honorariums from Johnson and Johnson, Olympus and Transmedic, the local distributor for the Da Vinci Robot. M.V.M. is a consultant for CAVA robotics LLC. J.P. reports a research grant from Intuitive Surgical Deutschland GmbH and personal fees or non-financial support from Johnson and Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma-consult Peterson, and Promedicis. M. Schmelzle reports personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson and Johnson, Takeda, Olympus, Medtronic, and Intuitive. A.A.F. reports receiving speaker fees from Bayer. F.R. reports speaker fees and support outside the submitted work from Integra, Medtronic, Olympus, Corza, Sirtex, and Johnson and Johnson. The remaining authors report no conflicts of interest.

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