Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches

Montalti, Roberto; Giglio, Mariano Cesare; Wu, Andrew G.R.; Cipriani, Francesco; D’Silva, Mizelle; Suhool, Amal; Nghia, Phan Phuoc; Kato, Yutaro; Lim, Chetana; Herman, Paulo; Coelho, Fabrício Ferreira; Schmelzle, Moritz; Pratschke, Johann; Qiu, Liu; Marino, Marco Vito; Belli, Andrea; Chiow, Adrian Kah Heng; Sucandy, Iswanto; Ivanecz, Arpad; Benedetto, Fabrizio Di; Choi, Sung Hoon; Lee, Jae Hoon; Park, James O.; Prieto, Mikel; Guzmán, Yoelimar; Fondevila, Constantino; Ефанов, Михаил; Rotellar, Fernando; Choi, Gi Hong; Robles‐Campos, Ricardo; Wang, Xiaoying; Sutcliffe, Robert P.; Tang, Chung Ngai; Chong, Charing C.N.; D’Hondt, Mathieu; Valle, Bernardo Dalla; Ruzzenente, Andrea; Kingham, T. Peter; Scatton, Olivier; Liu, Rong; Mejía, Alejandro; Mishima, Kazuo; Wakabayashi, Go; López‐Ben, Santiago; Pascual, Franco; Cherqui, Daniel; Forchino, Fabio; Ferrero, Alessandro; Ettorre, Giuseppe Maria; Sandri, Giovanni Battista Levi; Sugioka, Atsushi; Edwin, Bjørn; Cheung, Tan‐To; Long, Tran Cong Duy; Hilal, Mohammad Abu; Aldrighetti, Luca; Fuks, David; Han, Ho‐Seong; Troisi, Roberto; Goh, Brian K. P.; Syn, Nicholas; Gastaca, Mikel; Meurs, Juul; Meyere, Céline De; Lai, Eric C. H.; Krenzien, Felix; Kadam, Prashant; Lee, Kit‐Fai; Salimgereeva, Diana; Alikhanov, Ruslan; Lee, Lip-Seng; Jang, Jae Young; Labadie, Kevin P.; Kojima, Masayasu; Ghotbi, Jacob; Krüger, Jaime Arthur Pirola; López-López, Víctor; Magistri, Paolo; Colasanti, Marco; Robert, Margarida Casellas I; Saleh, Mansour; Poletto, Edoardo

doi:10.1245/s10434-023-13525-0

Cited by 9 publications

(3 citation statements)

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“…One interesting finding for our meta-analysis was of decreased conversion rate in the RMH versus LMH. A recent international multicenter study evaluating the risk factors and outcomes of open conversion during minimally invasive major hepatectomies on a total of 3880 patients has observed an overall conversion rate of 4.9% (33/669) in RMH group and 11.4% (366/3211) in LMH group 46 , this finding is near to the value shown for the RMH (4.6%) and LMH (10.7%) in our meta-analysis. Another multicenter study by Cipriani et al .…”

Section: Discussionsupporting

confidence: 54%

“…In other words, there could be no statistical difference in the conversion rate between the robotic and laparoscopic approaches for major hepatectomy when surgeons had surmounted the learning curve of minimally invasive major hepatectomy. Although RMH might be associated with a decreased risk of conversion compared with LMH, converted RMH showed increased postoperative mortality, serious postoperative complications, blood loss, and blood transfusion rate compared with converted LMH 46 . A potential advantage of robotic platform that reducing incidence of conversion to open surgery should be taken into account and prospective studies are warranted to assess whether this effect translates into improved patient outcomes for major hepatectomies in the future.…”

Section: Discussionmentioning

confidence: 92%

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Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: a systematic review and meta-analysis

Mao,

Zhu,

et al. 2023

International Journal of Surgery

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Background: Robotic platform has been increasingly applied in major hepatectomy. However, the role or advantage of robotic approach comparing with laparoscopic approach in major hepatectomy remains controversial. This meta-analysis compares perioperative outcomes of robotic major hepatectomy (RMH) to laparoscopic major hepatectomy (LMH) for hepatic neoplasms. Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify comparative studies compared RMH versus LMH for hepatic neoplasms. The search timeframe was set before May 2023. Main outcomes were mortality, overall morbidities, serious complications, and conversion to open surgery. Secondary outcomes were operative time, intraoperative blood loss, blood transfusion, postoperative length of hospital stay, R0 resection, reoperation, and readmission. Studies were evaluated for quality by Cochrane risk of bias tool or Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD#). Results: Twelve retrospective cohort studies concerning total 1657 patients (796 RMH, 861 LMH) were included. Meta-analyses showed no significant differences in mortality (OR=1.23, 95% CI=0.50–2.98, P=0.65), overall postoperative complications (OR=0.83, 95% CI=0.65–1.06, P=0.14), operative time (MD=6.47, 95% CI=−14.72 to 27.65, P=0.55), blood transfusion (OR=0.77, 95% CI=0.55–1.08, P=0.13), R0 resection (OR=1.45, 95% CI=0.91–2.31, P=0.12), reoperation (OR=0.76, 95% CI=0.31–1.88, P=0.56), and readmission (OR=0.63, 95% CI=0.28–1.44, P=0.27) between RMH and LMH. Incidence of serious complications (OR=0.60, 95% CI=0.40–0.90, P=0.01), conversion to open surgery (OR=0.41, 95% CI=0.27–0.63, P<0.0001), blood loss (MD=−91.42, 95% CI=−142.18 to −40.66, P=0.0004), and postoperative hospital stay (MD=−0.64, 95% CI=−0.78 to −0.49, P<0.00001) were reduced for RMH versus LMH. Conclusions: RMH is associated with comparable short-term surgical outcomes and oncologic adequacy compared to LMH when performed by experienced surgeons at large centers. RMH may result in reduced major morbidities, conversion rate, blood loss, and hospital stay, but these results were volatile. Further randomized studies should address the potential advantages of RMH over LMH.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 92%

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: a systematic review and meta-analysis

Mao,

Zhu,

et al. 2023

International Journal of Surgery

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“… 6 Indeed, it seems unlikely that further surgical advances, such as the use of robotic techniques, will be able to demonstrate an additional meaningful improvement. 35 , 36 …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial

Fichtinger,

Aldrighetti,

Abu Hilal

et al. 2024

JCO

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PURPOSE To compare outcomes after laparoscopic versus open major liver resection (hemihepatectomy) mainly for primary or metastatic cancer. The primary outcome measure was time to functional recovery. Secondary outcomes included morbidity, quality of life (QoL), and for those with cancer, resection margin status and time to adjuvant systemic therapy. PATIENTS AND METHODS This was a multicenter, randomized controlled, patient-blinded, superiority trial on adult patients undergoing hemihepatectomy. Patients were recruited from 16 hospitals in Europe between November 2013 and December 2018. RESULTS Of the 352 randomly assigned patients, 332 patients (94.3%) underwent surgery (laparoscopic, n = 166 and open, n = 166) and comprised the analysis population. The median time to functional recovery was 4 days (IQR, 3-5; range, 1-30) for laparoscopic hemihepatectomy versus 5 days (IQR, 4-6; range, 1-33) for open hemihepatectomy (difference, –17.5% [96% CI, –25.6 to –8.4]; P < .001). There was no difference in major complications (laparoscopic 24/166 [14.5%] v open 28/166 [16.9%]; odds ratio [OR], 0.84; P = .58). Regarding QoL, both global health status (difference, 3.2 points; P < .001) and body image (difference, 0.9 points; P < .001) scored significantly higher in the laparoscopic group. For the 281 (84.6%) patients with cancer, R0 resection margin status was similar (laparoscopic 106 [77.9%] v open 122 patients [84.1%], OR, 0.60; P = .14) with a shorter time to adjuvant systemic therapy in the laparoscopic group (46.5 days v 62.8 days, hazard ratio, 2.20; P = .009). CONCLUSION Among patients undergoing hemihepatectomy, the laparoscopic approach resulted in a shorter time to functional recovery compared with open surgery. In addition, it was associated with a better QoL, and in patients with cancer, a shorter time to adjuvant systemic therapy with no adverse impact on cancer outcomes observed.

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Evolution of laparoscopic liver resection in the last two decades: lessons from 2000 cases at a referral Korean center

Cassese,

Han,

Yoon

et al. 2023

Surg Endosc

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Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches

Cited by 9 publications

References 50 publications

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: a systematic review and meta-analysis

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: a systematic review and meta-analysis

Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial

Evolution of laparoscopic liver resection in the last two decades: lessons from 2000 cases at a referral Korean center

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