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Multicenter Study
. 2024 Feb 1;279(2):297-305.
doi: 10.1097/SLA.0000000000006027. Epub 2023 Jul 24.

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

Felix Krenzien  1 , Moritz Schmelzle  1 , Johann Pratschke  1 , Linda Feldbrügge  1 , Rong Liu  2 , Qu Liu  2 , Wanguang Zhang  3 , Joseph J Zhao  4 , Hwee-Leong Tan  4 , Federica Cipriani  5 , Tijs J Hoogteijling  6 , Davit L Aghayan  7 , Åsmund A Fretland  7 , Tiing Foong Siow  8 , Chetana Lim  9 , Olivier Scatton  9 , Paulo Herman  10 , Fabricio F Coelho  10 , Marco V Marino  11   12 , Vincenzo Mazzaferro  13 , Adrian K H Chiow  14 , Iswanto Sucandy  15 , Arpad Ivanecz  16 , Sung Hoon Choi  17 , Jae Hoon Lee  18 , Mikel Gastaca  19 , Marco Vivarelli  20 , Felice Giuliante  21 , Bernardo Dalla Valle  22 , Andrea Ruzzenente  22 , Chee-Chien Yong  23 , Zewei Chen  24 , Mengqiu Yin  24 , Constantino Fondevila  25   26 , Mikhail Efanov  27 , Zenichi Morise  28 , Fabrizio Di Benedetto  29 , Raffaele Brustia  30 , Raffaele Dalla Valle  31 , Ugo Boggi  32 , David Geller  33 , Andrea Belli  34 , Riccardo Memeo  35 , Salvatore Gruttadauria  36   37 , Alejandro Mejia  38 , James O Park  39 , Fernando Rotellar  40 , Gi-Hong Choi  41 , Ricardo Robles-Campos  42 , Xiaoying Wang  43 , Robert P Sutcliffe  44 , Kiyoshi Hasegawa  45 , Chung-Ngai Tang  46 , Charing C N Chong  47 , Kit-Fai Lee  47 , Juul Meurs  48 , Mathieu D'Hondt  48 , Kazuteru Monden  49 , Santiago Lopez-Ben  50 , T Peter Kingham  51 , Alessandro Ferrero  52 , Giuseppe M Ettorre  53 , Franco Pascual  54 , Daniel Cherqui  54 , Junhao Zheng  55 , Xiao Liang  55 , Olivier Soubrane  56 , Go Wakabayashi  57 , Roberto I Troisi  58 , Tan-To Cheung  59 , Yutaro Kato  60 , Atsushi Sugioka  60 , Safi Dokmak  61 , Mizelle D'Silva  62 , Ho-Seong Han  62 , Phan Phuoc Nghia  63 , Tran Cong Duy Long  63 , Mohammad Abu Hilal  6   64 , Kuo-Hsin Chen  8 , David Fuks  56 , Luca Aldrighetti  5 , Bjørn Edwin  7 , Brian K P Goh  4   65 ; International robotic and laparoscopic liver resection study group investigators
Collaborators, Affiliations
Free article
Multicenter Study

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

Felix Krenzien et al. Ann Surg. .
Free article

Abstract

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.

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Conflict of interest statement

The authors report no conflicts of interest.

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