Publication

Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy

Abstract
Importance: Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH). Objective: To compare the outcomes of robotic vs laparoscopic RH/ERH. Design, setting, and participants: In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included. Interventions: Robotic vs laparoscopic RH/ERH. Main outcomes and measures: Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed. Results: Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46). Conclusion and relevance: Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.
Author
Chong, Charing C
Fuks, David
Lee, Kit-Fai
Zhao, Joseph J
Choi, Gi Hong
Sucandy, Iswanto
Chiow, Adrian K H
Marino, Marco V
Gastaca, Mikel
Wang, Xiaoying
Lee, Jae Hoon
Efanov, Mikhail
Kingham, T Peter
D'Hondt, Mathieu
Troisi, Roberto I
Choi, Sung-Hoon
Sutcliffe, Robert P
Chan, Chung-Yip
Lai, Eric C H
Park, James O
Di Benedetto, Fabrizio
Rotellar, Fernando
Sugioka, Atsushi
Coelho, Fabricio Ferreira
Ferrero, Alessandro
Long, Tran Cong Duy
Lim, Chetana
Scatton, Olivier
Liu, Qu
Schmelzle, Moritz
Pratschke, Johann
Cheung, Tan-To
Liu, Rong
Han, Ho-Seong
Tang, Chung Ngai
Goh, Brian K P
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Date
2022-03-09
Type
Article
Subject
Gastroenterology, Surgery
Collections
UHB Gastroenterology
Posters
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Citation
Chong CC, Fuks D, Lee KF, Zhao JJ, Choi GH, Sucandy I, Chiow AKH, Marino MV, Gastaca M, Wang X, Lee JH, Efanov M, Kingham TP, D'Hondt M, Troisi RI, Choi SH, Sutcliffe RP, Chan CY, Lai ECH, Park JO, Di Benedetto F, Rotellar F, Sugioka A, Coelho FF, Ferrero A, Long TCD, Lim C, Scatton O, Liu Q, Schmelzle M, Pratschke J, Cheung TT, Liu R, Han HS, Tang CN, Goh BKP; International Robotic and Laparoscopic Liver Resection study group investigators. Propensity Score-Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy. JAMA Surg. 2022 May 1;157(5):436-444. doi: 10.1001/jamasurg.2022.0161.
Journal / Source Title
JAMA Surgery
DOI
10.1001/jamasurg.2022.0161
URI
http://hdl.handle.net/20.500.14200/6299
PMID
35262660
Publisher
American Medical Association
Publisher’s URL
https://jamanetwork.com/journals/jamasurgery
Publisher’s statement
Note / Copyright