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. 2024 Sep 5.
doi: 10.1097/SLA.0000000000006523. Online ahead of print.

Propensity Score-matched Analysis Comparing Robotic Versus Laparoscopic Minor Liver Resections of the Anterolateral Segments: an International Multi-center Study of 10,517 Cases

Jie Hu  1 , Yuxin Guo  2 , Xiaoying Wang  1 , Marcus Yeow  3 , Andrew G R Wu  3 , David Fuks  4 , Olivier Soubrane  4 , Safi Dokmak  5 , Salvatore Gruttadauria  6 , Giuseppe Zimmitti  7 , Francesca Ratti  8 , Yutaro Kato  9 , Olivier Scatton  10 , Paulo Herman  11 , Davit L Aghayan  12 , Marco V Marino  13 , Roland S Croner  14 , Vincenzo Mazzaferro  15 , Adrian K H Chiow  16 , Iswanto Sucandy  17 , Arpad Ivanecz  18 , Sung Hoon Choi  19 , Jae Hoon Lee  20 , Mikel Gastaca  21 , Marco Vivarelli  22 , Felice Giuliante  23 , Andrea Ruzzenente  24 , Chee-Chien Yong  25 , Mengqiu Yin  26 , Constantino Fondevila  27 , Mikhail Efanov  28 , Zenichi Morise  29 , Fabrizio Di Benedetto  30 , Raffaele Brustia  31 , Raffaele Dalla Valle  32 , Ugo Boggi  33 , David Geller  34 , Andrea Belli  35 , Riccardo Memeo  36 , Alejandro Mejia  37 , James O Park  38 , Fernando Rotellar  39 , Gi-Hong Choi  40 , Ricardo Robles-Campos  41 , Kiyoshi Hasegawa  42 , Rutger-Jan Swijnenburg  43 , Robert P Sutcliffe  44 , Johann Pratschke  45 , Eric C H Lai  46 , Charing C N Chong  47 , Mathieu D'Hondt  48 , Kazuteru Monden  49 , Santiago Lopez-Ben  50 , T Peter Kingham  51 , Moritz Schmelzle  52 , Jason Hawksworth  53 , Yufu Peng  54 , Alessandro Ferrero  55 , Giuseppe Maria Ettorre  56 , Daniel Cherqui  57 , Xiao Liang  58 , Go Wakabayashi  59 , Roberto I Troisi  60 , Umberto Cillo  61 , Tan-To Cheung  62 , Motokazu Sugimoto  63 , Atsushi Sugioka  9 , Ho-Seong Han  64 , Tran Cong Duy Long  65 , Mohammad Abu Hilal  7   66 , Wanguang Zhang  67 , Yonggang Wei  54 , Kuo-Hsin Chen  68 , Luca Aldrighetti  8 , Bjorn Edwin  12 , Rong Liu  69 , Brian K P Goh  2   68 ; International robotic and laparoscopic liver resection study group investigators
Collaborators, Affiliations

Propensity Score-matched Analysis Comparing Robotic Versus Laparoscopic Minor Liver Resections of the Anterolateral Segments: an International Multi-center Study of 10,517 Cases

Jie Hu et al. Ann Surg. .

Abstract

Objective: To compare the outcomes of robotic minor liver resections (RMLR) versus laparoscopic (L) MLR of the anterolateral segments.

Background: Robotic liver surgery has been gaining prominence over the years with increasing usage for a myriad of hepatic resections. Robotic liver resections(RLR) has demonstrated non-inferiority to laparoscopic(L)LR while illustrating advantages over conventional laparoscopy especially for technically difficult and major LR. However, the advantage of RMLR for the anterolateral(AL) (segments II, III, IVb, V and VI) segments, has not been clearly demonstrated.

Methods: Between 2008 to 2022, 15,356 of 29,861 patients from 68 international centres underwent robotic(R) or laparoscopic minor liver resections (LMLR) for the AL segments Propensity score matching (PSM) analysis was performed for matched analysis.

Results: 10,517 patients met the study criteria of which 1,481 underwent RMLR and 9,036 underwent LMLR. A PSM cohort of 1,401 patients in each group were identified for analysis. Compared to the LMLR cohort, the RMLR cohort demonstrated significantly lower median blood loss (75ml vs. 100ml, P<0.001), decreased blood transfusion (3.1% vs. 5.4%, P=0.003), lower incidence of major morbidity (2.5% vs. 4.6%, P=0.004), lower proportion of open conversion (1.2% vs. 4.5%, P<0.001), shorter post operative stay (4 days vs. 5 days, P<0.001), but higher rate of 30-day readmission (3.5% vs. 2.1%, P=0.042). These results were then validated by a 1:2 PSM analysis. In the subset analysis for 3,614 patients with cirrhosis, RMLR showed lower median blood loss, decreased blood transfusion, lower open conversion and shorter post operative stay than LMLR.

Conclusion: RMLR demonstrated statistically significant advantages over LMLR even for resections in the AL segments although most of the observed clinical differences were minimal.

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Conflict of interest statement

The authors report no conflicts of interest.

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