Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments

Abstract

Objective: To compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments. Background: Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in existing literature. Methods: This is a post hoc analysis of a multicenter database of 5,446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumour features and perioperative characteristics were collected and analysed. Propensity score matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias. Results: A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%) and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate (10 of 449 [2.2%] vs. 54 of 898 [6.0%]; P=0.002), less blood loss (100 mL [IQR; 50-200] days vs. 150 mL [IQR; 50-350]; P<0.001) and a shorter operative time (188 min [IQR; 140-270] vs. 222 min [IQR; 158-300]; P<0.001). These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis - lower open conversion rate (1 of 136 [0.7%] vs. 17 of 272 [6.2%]; P=0.009), less blood loss (100 mL [IQR; 48-200] vs. 160 mL [IQR; 50-400]; P<0.001) and shorter operative time (190 min [IQR; 141-258] vs. 230 min [IQR; 160-312]; P=0.003). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset. Conclusion: RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss and open conversion rate when compared to LLLR.

Hepatocellular Carcinoma: The Role of Surgery in Liver Cirrhosis

“…In a recently published analysis, the international robotic and laparoscopic liver resection study group compared groups of laparoscopic (3,049) with robotic liver resections (461) of posterosuperior segments in a post hoc multicenter analysis. In this analysis, robotic surgery was favorable in terms of shorter operative time, less blood loss, and decreased open conversion rate over laparoscopic cases [56]. An additional plus is that robotic surgery implies higher grades of freedom and with this allows access to liver segments that are not or only hardly accessible by laparoscopy.…”

Optimized reusable modular 3D-printed models of choledochal cyst to simulate laparoscopic and robotic bilioenteric anastomosis

“…With the continuous improvement of laparoscopic-related instruments and surgeons' operating techniques, the scope of application of laparoscopic surgery is also expanding. Similarly, robotic surgery is gaining increasing popularity among patients, with similar or even better perioperative outcomes compared to laparoscopic surgery 7 . Nowadays, laparoscopic surgery and robotic surgery have become the surgical treatment of choice for many diseases.…”

Validation of the IWATE Criteria in Robotic-Assisted Liver Resections

“…RALR provides a greater range of motion, high-resolution 3D visualization, elimination of the surgeon's tremor and improvement of the surgeon's ergonomics [13][14][15]. This results in comparable postoperative outcomes but lower conversion rates and less intraoperative blood loss in comparison to LLRs [13,[16][17][18][19][20][21][22][23].…”