Scientific publications

Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis. Scientific Publication

Dec 1, 2022 | Magazine: Annals of Surgical Oncology

Iswanto Sucandy #  1 , Shlomi Rayman #  1 , Eric C Lai  2 , Chung-Ngai Tang  2 , Yvette Chong  3 , Mikhail Efanov  4 , David Fuks  5 , Gi-Hong Choi  6 , Charing C Chong  7 , Adrian K H Chiow  8 , Marco V Marino  9   10 , Mikel Prieto  11 , Jae-Hoon Lee  12 , T Peter Kingham  13 , Mathieu D'Hondt  14 , Roberto I Troisi  15 , Sung Hoon Choi  16 , Robert P Sutcliffe  17 , Tan-To Cheung  18 , Fernando Rotellar  19   20 , James O Park  21 , Olivier Scatton  22 , Ho-Seong Han  23 , Johann Pratschke  24 , Xiaoying Wang  25 , Rong Liu  26 , Brian K P Goh  27   28 , International Robotic, Laparoscopic Liver Resection Study Group Investigators


Background: Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database.

Methods: An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade.

Results: Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009).

Conclusion: Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.

CITATION Ann Surg Oncol. 2022 Dec;29(13):8398-8406. doi: 10.1245/s10434-022-12216-6. Epub 2022 Aug 23.