Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.
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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, International robotic and laparoscopic liver resection study group investigators
Аннотация
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.