Robotic versus open resection for colorectal liver metastases in a “referral centre Hub&Spoke learning program”. A multicenter propensity score matching analysis of perioperative outcomes
Aldo Rocca, Pasquale Avella, Andrea Scacchi, Maria Chiara Brunese, Micaela Cappuccio, Michele De Rosa, Alberto Bartoli, Germano Guerra, Fulvio Calise, Graziano Ceccarelli
Abstract
BackgroundSurgical resection is the best treatment for colorectal liver metastasis (CRLM). Although laparoscopic and robotic surgery demonstrated their reliability especially in referral centers, comparison between perioperative outcomes of robotic (RLR) and open (OLR) liver surgery is still debate considering liver resections performed in referral centers for robotic surgery, but not dedicated to HPB. Our study aimed to verify the efficacy and safety of perioperative outcomes after RLR and OLR for CRLM in an HUB&Spoke learning program (H&S) between an high volume center for liver surgery and an high volume centers for robotic surgery.MethodsWe analyzed prospective databases of Pineta Grande Hospital (Castel Volturno), A. Cardarelli Hospital (Campobasso) and Robotic Surgical Units (Foligno-Spoleto and Arezzo) from 2011 to 2021. A 1:1 propensity score matching (PSM) was performed according to baseline characteristics of patients, solitary/multiple CRLM, anterolateral/posterosuperior location.Results383 patients accepted to be part of the study (268 ORL and 115 RLR). After PSM, 45 patients from each group were included. Conversion rate was 8.89 %. RLR group had a significantly lower blood loss (226 vs. 321 ml; p=0.0001), and fewer major complications (13.33 % vs. 17.78 %; p=0.7722). R0 resection was obtained in 100 % of OLR (vs. 95.55 %). Hospital stay was 8.8 days in RLR (vs. 15; p=0.0001). Conclusion: H&S represents a safe and effective program to train general surgeons also in Hepatobiliary surgery providing R0 resection rate, blood loss volume and morbidity rate superimposable to referral centers. Furthermore, H&S allow a reduction of health mobility with consequent money saving for patients and institutions.