Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches
Mizelle D'Silva 1 , Ho-Seong Han 1 , Rong Liu 2 , Thomas Peter Kingham 3 , Gi-Hong Choi 4 , Nicholas Li-Xun Syn 5 , Mikel Prieto 6 , Sung-Hoon Choi 7 , Iswanto Sucandy 8 , Adrian Kah Heng Chiow 9 , Marco Vito Marino 10 , Mikhail Efanov 11 , Jae-Hoon Lee 12 , Robert Peter Sutcliffe 13 , Charing Ching Ning Chong 14 , Chung-Ngai Tang 15 , Tan-To Cheung 16 , Johann Pratschke 17 , Xiaoying Wang 18 , James Oh Park 19 , Chung Yip Chan 20 , Olivier Scatton 21 , Fernando Rotellar 22 , Roberto Ivan Troisi 23 , Mathieu D'Hondt 24 , David Fuks 25 , Brian Kim Poh Goh 20 , international robotic and laparoscopic liver resection study group investigators
Background: Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).
Methods: This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.
Results: Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40-200) versus 200 (100-500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20-46) versus 40 (25-58) min; P = 0.012), and median duration of operation (175 (130-255) versus 224 (155-300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.
Conclusion: Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.
CITATION Br J Surg. 2022 Oct 14;109(11):1140-1149. doi: 10.1093/bjs/znac270