Scientific publications

Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments: An International Multi-Center Study. Scientific Publication

Jul 24, 2023 | Magazine: Annals of Surgery

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


Objective: 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 existing literature.

Methods: This is a post hoc analysis of a multicenter database of 5,446 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, tumour features and perioperative characteristics were collected and analysed. 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). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.

Conclusion: 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 to LLLR.

CITATION  Ann Surg. 2023 Jul 24.  doi: 10.1097/SLA.0000000000006027