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