Scientific publications

An international multicenter propensity-score matched and coarsened-exact matched analysis comparing between robotic versus laparoscopic partial liver resections of the anterolateral segments

Apr 7, 2022 | Magazine: Journal of Hepato-biliary-pancreatic Sciences

Prashant Kadam  1 , Robert P Sutcliffe  1 , Olivier Scatton  2 , Iswanto Sucandy  3 , T Peter Kingham  4 , Rong Liu  5 , Gi Hong Choi  6 , Nicholas L Syn  7 , Mikel Gastaca  8 , Sung-Hoon Choi  9 , Adrian K H Chiow  10 , Marco V Marino  11 , Mikhail Efanov  12 , Jae-Hoon Lee  13 , Charing C Chong  14 , Chung-Ngai Tang  15 , Tan-To Cheung  16 , Johann Pratschke  17 , Xiaoying Wang  18 , Ricardo Robless Campos  19 , Arpad Ivanecz  20 , James O Park  21 , Fernando Rotellar  22 , David Fuks  23 , Mathieu D'Hondt  24 , Ho-Seong Han  25 , Roberto I Troisi  26 , Brian K P Goh  27 , International robotic and laparoscopic liver resection study group investigators

Background: Robotic liver resections RLR may have the ability to address some of the drawbacks of laparoscopic(L)LR but few studies have done a head-to-head comparison of the outcomes after anterolateral segment resections by the two techniques.

Methods: A retrospective study was conducted of 3202 patients who underwent minimally-invasive LR of the anterolateral liver segments at 26 international centres from 2005 to 2020. 2606 cases met study criteria of which there were 358 RLR and 1868 LLR. Peri-operative outcomes were compared between the two groups using a 1:3 Propensity Score Matched(PSM) and 1:1 Coarsened Exact Matched(CEM) analysis.

Results: Patients matched after 1:3 PSM(261 RLR vs. 783 LLR) and 1:1 CEM(296 RLR vs. 296 LLR) revealed no significant differences in length of stay, readmission rates, morbidity, mortality and involvement of or close oncological margins. RLR surgeries were associated with significantly less blood loss(50ml vs. 100ml, p<0.001) and lower rates of open conversion on both PSM(1.5% vs. 6.8%, p=0.003) and CEM(1.4% vs. 6.4%, p=0.004) compared to LLR. Though PSM analysis showed RLR to have a longer operating time than LLR(170 min vs. 160 min, p=0.036), this difference proved to be insignificant on CEM(167 min vs. 163 min. p=0.575).

Conclusion: This multicentre international combined PSM and CEM study showed that both RLR and LLR have equivalent perioperative outcomes when performed in selected patients at high volume centres. The robotic approach was associated with significantly lower blood loss and allowed more surgeries to be completed in a minimally-invasive fashion.

CITATION  J Hepatobiliary Pancreat Sci. 2022 Aug;29(8):843-854. doi: 10.1002/jhbp.1149.  Epub 2022 Apr 27.