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

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.

Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score-matched study of 10,075 patients

“…44 A study by Liu et al, which focused on major liver resections, found less intraoperative blood loss, Pringle application, and lower conversion rates, similar to our subgroup analysis of major liver resections. 43 Their study also found a significant difference in length of hospital stay (6 vs. 7 days), which in the present study was equal in both groups (5 days), possibly owing to national extramural healthcare differences between the participating centers. An interesting area for future research would also be the assessment of the efficacy of RLS in specific patient populations, such as patients affected by obesity or cirrhosis, as the absence of the CUSA in RLS might especially lead to difficulties during parenchymal transection in patients with chronic liver disease and cirrhosis.…”

“…39,40 In our analysis, we consistently found lower Pringle usage and shorter duration in the RLS group, which is in line with earlier reports. [41][42][43] Nevertheless, RLS was associated with slightly less blood loss and lower transfusion rates. In a meta-analysis by Gavriilidis et al both RLS and LLS were associated with comparable intraoperative amounts of blood loss, but more recent reports also support the marginal benefits of RLS, with regards to blood loss and transfusion, observed in this study.…”

“…In a meta-analysis by Gavriilidis et al both RLS and LLS were associated with comparable intraoperative amounts of blood loss, but more recent reports also support the marginal benefits of RLS, with regards to blood loss and transfusion, observed in this study. 13,[43][44][45] These findings indicate that, despite the absence of Cavitron Ultrasonic Surgical Aspirator (CUSA®, Integra LifeSciences Corporation) in the robotic toolkit, the robotic approach may offer a greater degree of bleeding control. One possible explanation for this could be the aforementioned stable surgical field, which facilitates improved visualization and allows for a more controlled and safer dissection of the vasculo-biliary structures within the liver parenchyma and at the hepatic hilum.…”

“…15 Some authors have suggested that the decrease in conversion rates is related to the fact that there is less need to convert to achieve oncological radicality and control bleeding in RLS. 16,43 The exact reason for this difference however remains unclear, warranting additional studies focusing on this topic. Conversions, especially when in an emergency setting, have been associated with inferior postoperative outcomes.…”

Persistent poverty impacts access to minimally invasive surgery among patients with hepatopancreatobiliary cancer

“…There is increasing evidence of improved clinical and oncological outcomes after MIS. 23 Laparoscopic and robotic surgery have been associated with better short-term outcomes compared with open surgery, despite some reports of longer operating time. 24,25 Despite the potential benefits of an MIS approach, community characteristics may strongly impact access to healthcare technology.…”