Minimally Invasive vs Open Major Hepatectomies for Liver Malignancies: a Propensity Score–Matched Analysis

Chin, Ken Min; Linn, Yun Le; Cheong, Chin Kai; Koh, Ye‐Xin; Teo, Jin‐Yao; Chung, Alexander Yaw Fui; Chan, Chung Yip; Goh, Brian K. P.

doi:10.1007/s11605-021-05226-4

Cited by 16 publications

(9 citation statements)

References 46 publications

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“…inimally invasive liver surgery is a safe and effective procedure for resecting both primary and metastatic liver tumors. 1,2 However, complex laparoscopic liver resections, particularly of posterior segments or in the treatment of cirrhosis, require a longer learning curve than standard resections to be performed proficiently and safely. 3 Therefore, open hepatectomies may still be preferred in certain cases as an oncologically adequate procedure.…”

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Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

et al. 2023

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ImportanceLong-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology, but sparse data have been published thus far.ObjectiveTo analyze short- and long-term outcomes of robotic liver resection (RLR) for hepatocellular carcinoma (HCC) from Western high-volume centers to assess the safety, reproducibility, and oncologic efficacy of this technique.Design, Setting, and ParticipantsThis cohort study evaluated the outcomes of patients receiving RLR vs open liver resection (OLR) for HCC between 2010 and 2020 in 5 high-volume centers. After 1:1 propensity score matching, a group of patients who underwent RLR was compared with a validation cohort of OLR patients from a high-volume center that did not perform RLR.Main Outcomes and MeasuresA retrospective analysis was performed of prospectively maintained databases at 2 European and 2 US institutions of patients who underwent RLR for HCC between January 1, 2010, and September 30, 2020. The main outcomes were safety and feasibility of RLR for HCC and its oncologic outcomes compared with a European OLR validation cohort. A 2-sided P &lt; .05 was considered significant.ResultsThe study included 398 patients (RLR group: 125 men, 33 women, median [IQR] age, 66 [58-71] years; OLR group: 315 men, 83 women; median [IQR] age, 70 [64-74] years), and 106 RLR patients were compared with 106 OLR patients after propensity score matching. The RLR patients had a significantly longer operative time (median [IQR], 295 [190-370] minutes vs 200 [165-255] minutes, including docking; P &lt; .001) but a significantly shorter hospital length of stay (median [IQR], 4 [3-6] days vs 10 [7-13] days; P &lt; .001) and a lower number of admissions to the intensive care unit (7 [6.6%] vs 21 [19.8%]; P = .002). Incidence of posthepatectomy liver failure was significantly lower in the RLR group (8 [7.5%] vs 30 [28.3%]; P = .001), with no cases of grade C failure. The 90-day overall survival rate was comparable between the 2 groups (RLR, 99.1% [95% CI, 93.5%-99.9%]; OLR, 97.1% [95% CI, 91.3%-99.1%]), as was the cumulative incidence of death related to tumor recurrence (RLR, 8.8% [95% CI, 3.1%-18.3%]; OLR, 10.2% [95% CI, 4.9%-17.7%]).Conclusions and RelevanceThis study represents the largest Western experience to date of full RLR for HCC. Compared with OLR, RLR performed in tertiary centers represents a safe treatment strategy for patients with HCC and those with compromised liver function while achieving oncologic efficacy.

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Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

et al. 2023

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“…[2][3][4] Various international consensuses also recommended LLR as the standard approach for benign and malignant liver tumors, with the advantages of minimally invasive and rapid recovery. [5][6][7][8][9] However, the limited motion and flexibility of laparoscopic instruments, the high technical skills required, and its long learning curve have resulted in laparoscopic major hepatectomy(L-MH) remaining in the exploratory phase in many centers and it is associated with a significant open conversion rate. 10,11 The robotic system was designed to overcome the limitations of traditional laparoscopic surgery.…”

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“…With the application of laparoscopic techniques to liver resection(LR) in the early 1990s, 1 the extent of resection for laparoscopic liver resection(LLR) has become increasingly extensive, including most of the region from the left lateral segment to the posterosuperior segment 2–4 . Various international consensuses also recommended LLR as the standard approach for benign and malignant liver tumors, with the advantages of minimally invasive and rapid recovery 5–9 . However, the limited motion and flexibility of laparoscopic instruments, the high technical skills required, and its long learning curve have resulted in laparoscopic major hepatectomy(L-MH) remaining in the exploratory phase in many centers and it is associated with a significant open conversion rate 10,11 …”

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Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies

et al. 2023

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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.

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“…With the increasing understanding of liver anatomy and the progress of medical equipment, laparoscopic liver resection (LLR) increased in frequency and complexity. Many studies have shown that LLR and minor hepatectomy have less intraoperative bleeding, fewer postoperative complications and shorter hospital stay compared with open liver resection (OLR) and major hepatectomy [ 43 – 45 ]. In order to avoid bias, we compared them in this study, and found that each group was balanced (operation mode [ p = 0.125] and type of hepatectomy [ p = 0.692]).…”

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confidence: 99%

Sarcopenia negatively affects postoperative short-term outcomes of patients with non-cirrhosis liver cancer

Yang

Wang

et al. 2023

BMC Cancer

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Background Literature review have shown that sarcopenia substantially alters the postoperative outcomes after liver resection for malignant tumors. However, these retrospective studies do not distinguish cirrhotic and non-cirrhotic liver cancer patients, nor combine the assessment of muscle strength in addition to muscle mass. The purpose of this study is to study the relationship between sarcopenia and short-term outcomes after hepatectomy in patients with non-cirrhotic liver cancer. Methods From December 2020 to October 2021, 431 consecutive inpatients were prospectively enrolled in this study. Muscle strength and mass were assessed by handgrip strength and the skeletal muscle index (SMI) on preoperative computed tomographic scans, respectively. Based on the SMI and the handgrip strength, patients were divided into four groups: group A (low muscle mass and strength), group B (low muscle mass and normal muscle strength), group C (low muscle strength and normal muscle mass), and group D (normal muscle mass and strength). The main outcome was major complications and the secondary outcome was 90-d Readmission rate. Results After strictly exclusion, 171 non-cirrhosis patients (median age, 59.00 [IQR, 50.00–67.00] years; 72 females [42.1%]) were selected in the final analysis. Patients in group A had a statistically significantly higher incidence of major postoperative complications (Clavien–Dindo classification ≥ III) (26.1%, p = 0.032), blood transfusion rate (65.2%, p < 0.001), 90-day readmission rate (21.7%, p = 0.037) and hospitalization expenses (60,842.00 [IQR, 35,563.10–87,575.30], p < 0.001) than other groups. Sarcopenia (hazard ratio, 4.21; 95% CI, 1.44–9.48; p = 0.025) and open approach (hazard ratio, 2.56; 95% CI, 1.01–6.49; p = 0.004) were independent risk factors associated with major postoperative complications. Conclusions Sarcopenia is closely related to poor short-term postoperative outcomes in non-cirrhosis liver cancer patients and the assessment that combines muscle strength and muscle mass can simply and comprehensively identify it. Trial registration ClinicalTrials.gov identifiers NCT04637048. (19/11/2020).

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Minimally Invasive vs Open Major Hepatectomies for Liver Malignancies: a Propensity Score–Matched Analysis

Cited by 16 publications

References 46 publications

Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma

Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies

Sarcopenia negatively affects postoperative short-term outcomes of patients with non-cirrhosis liver cancer

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