Postoperative infectious complications following robotic versus laparoscopic hepatectomy for hepatocellular carcinoma: a multicenter propensity score analysis.

OBJECTIVES

Hepatocellular carcinoma (HCC) often requires hepatectomy, a surgery that can be complicated by significant postoperative morbidity, particularly infectious events. This study aimed to compare robotic and laparoscopic hepatectomy to assess their associations with the occurrence of postoperative infectious complications.

METHODS

Data pooled from multiple centers were reviewed to identify HCC patients who underwent either robotic hepatectomy (RH) or laparoscopic hepatectomy (LH). To examine the relationship between surgical approach and postoperative infectious outcomes, including incisional surgical-site infection (SSI), organ/space SSI, and remote infections (RI), we employed propensity score matching (PSM) as the primary analytical method, with inverse probability of treatment weighting (IPTW) performed as a sensitivity analysis to assess the robustness of the findings.

RESULTS

Of the 418 patients included, 88 (21.1%) underwent robotic hepatectomy (RH) and 330 (78.9%) had laparoscopic hepatectomy (LH). The overall infection rate was lower in the RH cohort than in the LH cohort (5.68% vs. 14.8%; P = 0.036). Breakdown by infection type showed lower rates with RH: incisional SSI 3.41% versus 10.3% (P = 0.07), organ/space SSI 3.41% versus 10.9% (P = 0.052), and remote infection 2.27% versus 9.39% (P = 0.048). After propensity score matching, the RH group's rates were 5.68% (overall), 3.41% (incisional SSI), 3.41% (organ/space SSI), and 2.27% (RI) compared with 22.7%, 13.6%, 13.6%, and 11.4% in the matched LH group. The IPTW-weighted analyses yielded similar differences: RH versus LH-overall infection 5.6% versus 15.1%, incisional SSI 3.4% versus 10.5%, organ/space SSI 3.7% versus 11.3%, and RI 1.9% versus 9.5%. Finally, after controlling for other covariates in multivariable models, RH remained independently associated with reduced odds of overall infection, incisional SSI, organ/space SSI, and remote infection across the unadjusted, PSM, and IPTW analyses.

CONCLUSION

Robotic hepatectomy was independently associated with lower rates of postoperative infectious complications compared with laparoscopic hepatectomy in patients with HCC.