1. Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis
- Author
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Sucandy I., Rayman S., Lai E. C., Tang C. -N., Chong Y., Efanov M., Fuks D., Choi G. -H., Chong C. C., Chiow A. K. H., Marino M. V., Prieto M., Lee J. -H., Kingham T. P., D'Hondt M., Troisi R. I., Choi S. H., Sutcliffe R. P., Cheung T. -T., Rotellar F., Park J. O., Scatton O., Han H. -S., Pratschke J., Wang X., Liu R., Goh B. K. P., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Krenzien F., Schmelzle M., Kadam P., Montalti R., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. S., Gastaca M., Jang J. Y., Lim C., Labadie K. P., Sucandy, I., Rayman, S., Lai, E. C., Tang, C. -N., Chong, Y., Efanov, M., Fuks, D., Choi, G. -H., Chong, C. C., Chiow, A. K. H., Marino, M. V., Prieto, M., Lee, J. -H., Kingham, T. P., D'Hondt, M., Troisi, R. I., Choi, S. H., Sutcliffe, R. P., Cheung, T. -T., Rotellar, F., Park, J. O., Scatton, O., Han, H. -S., Pratschke, J., Wang, X., Liu, R., Goh, B. K. P., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. S., Gastaca, M., Jang, J. Y., Lim, C., and Labadie, K. P.
- Subjects
Oncology ,Surgery - Abstract
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.
- Published
- 2022
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