학술논문
Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases
Document Type
Academic Journal
Author
Liu, Qu; Zhang, Wanguang; Zhao, Joseph J.; Syn, Nicholas L.; Cipriani, Federica; Alzoubi, Mohammad; Aghayan, Davit L.; Siow, Tiing-Foong; Lim, Chetana; Scatton, Olivier; Herman, Paulo; Coelho, Fabricio Ferreira; Marino, Marco V.; Mazzaferro, Vincenzo; Chiow, Adrian K. H.; Sucandy, Iswanto; Ivanecz, Arpad; Choi, Sung-Hoon; Lee, Jae Hoon; Prieto, Mikel; Vivarelli, Marco; Giuliante, Felice; Dalla Valle, Bernardo; Ruzzenente, Andrea; Yong, Chee-Chien; Chen, Zewei; Yin, Mengqiu; Fondevila, Constantino; Efanov, Mikhail; Morise, Zenichi; Di Benedetto, Fabrizio; Brustia, Raffaele; Dalla Valle, Raffaele; Boggi, Ugo; Geller, David; Belli, Andrea; Memeo, Riccardo; Gruttadauria, Salvatore; Mejia, Alejandro; Park, James O.; Rotellar, Fernando; Choi, Gi-Hong; Robles-Campos, Ricardo; Wang, Xiaoying; Sutcliffe, Robert P.; Schmelzle, Moritz; Pratschke, Johann; Tang, Chung-Ngai; Chong, Charing C. N.; Lee, Kit-Fai; Meurs, Juul; D’Hondt, Mathieu; Monden, Kazuteru; Lopez-Ben, Santiago; Kingham, Thomas Peter; Ferrero, Alessandro; Ettorre, Giuseppe Maria; Levi Sandri, Giovanni Battista; Saleh, Mansour; Cherqui, Daniel; Zheng, Junhao; Liang, Xiao; Mazzotta, Alessandro; Soubrane, Olivier; Wakabayashi, Go; Troisi, Roberto I.; Cheung, Tan-To; Kato, Yutaro; Sugioka, Atsushi; D’Silva, Mizelle; Han, Ho-Seong; Nghia, Phan Phuoc; Long, Tran Cong duy; Edwin, Bjørn; Fuks, David; Chen, Kuo-Hsin; Abu Hilal, Mohammad; Aldrighetti, Luca; Liu, Rong; Goh, Brian K. P.; Gastaca, Mikel; De Meyere, Celine; Ng, Kelvin K.; Salimgereeva, Diana; Alikhanov, Ruslan; Lee, Lip-Seng; Jang, Jae Young; Kojima, Masayuki; Kruger, Jaime Arthur Pirola; Lopez-Lopez, Victor; Casellas I Robert, Margarida; Roberto, Montalti; Giglio, Mariano; Lee, Boram; Wang, Hao-Ping; Pascual, Franco; Yu, Shian; Vani, Simone; Ardito, Francesco; Giustizieri, Ugo; Citterio, Davide; Mocchegiani, Federico; Colasanti, Marco; Guzmán, Yoelimar; Labadie, Kevin P.; Conticchio, Maria; Dogeas, Epameinondas; Kauffmann, Emanuele F.; Giuffrida, Mario; Sommacale, Daniele; Laurent, Alexis; Magistri, Paolo; Mishima, Kohei; Krenzien, Felix; Kadam, Prashant; Lai, Eric C. H.; Ghotbi, Jacob; Fretland, Åsmund Avdem; Forchino, Fabio
Source
Annals of Surgery. Dec 01, 2023 278(6):969-975
Subject
Language
English
ISSN
0003-4932
Abstract
OBJECTIVE:: To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH). BACKGROUND:: Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH. METHODS:: This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups RESULTS:: A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047]. CONCLUSIONS:: This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.