Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy
Charing C Chong 1 , David Fuks 2 , Kit-Fai Lee 1 , Joseph J Zhao 3 , Gi Hong Choi 4 , Iswanto Sucandy 5 , Adrian K H Chiow 6 , Marco V Marino 7 , Mikel Gastaca 8 , Xiaoying Wang 9 , Jae Hoon Lee 10 , Mikhail Efanov 11 , T Peter Kingham 12 , Mathieu D'Hondt 13 , Roberto I Troisi 14 , Sung-Hoon Choi 15 , Robert P Sutcliffe 16 , Chung-Yip Chan 17 , Eric C H Lai 18 , James O Park 19 , Fabrizio Di Benedetto 20 , Fernando Rotellar 21 22 , Atsushi Sugioka 23 , Fabricio Ferreira Coelho 24 , Alessandro Ferrero 25 , Tran Cong Duy Long 26 , Chetana Lim 27 , Olivier Scatton 27 , Qu Liu 28 , Moritz Schmelzle 29 , Johann Pratschke 29 , Tan-To Cheung 30 , Rong Liu 28 , Ho-Seong Han 31 , Chung Ngai Tang 18 , Brian K P Goh 17 , International Robotic and Laparoscopic Liver Resection study group investigators
Importance: Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH).
Objective: To compare the outcomes of robotic vs laparoscopic RH/ERH.
Design, setting, and participants: In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included.
Interventions: Robotic vs laparoscopic RH/ERH.
Main outcomes and measures: Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed.
Results: Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis.
Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048).
On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46).
Conclusion and relevance: Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.