Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies
Qu Liu, Wanguang Zhang, Joseph J. Zhao, Nicholas Syn, Federica Cipriani, Mohammad Alzoubi, Davit L. Aghayan, Tiing-Foong Siow, Chétana Lim, Olivier Scatton, Paulo Herman, Fabrício Ferreira Coelho, Marco V. Marino, Vincenzo Mazzaferro, Adrian Kah Heng Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Bernardo Dalla Valle, Andrea Ruzzenente, Chee‐Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Михаил Ефанов, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David A. Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O. Park, Fernando Rotellar, Gi Hong Choi, R Robles, Xiaoying Wang, R. Sutcliffe, Moritz Schmelzle, Johann Pratschke, Chung‐Ngai Tang, Charing C. N. Chong, Kit‐Fai Lee, Juul Meurs, Mathieu D’Hondt, Kazuteru Monden, Santiago López‐Ben, Thomas Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Mansour Saleh, Daniel Cherqui, Junhao Zheng, Xiao Liang, Alessandro Mazzotta, Olivier Soubrane, Go Wakabayashi, Roberto Troisi, Tan To Cheung, Yutaro Kato, Atsushi Sugioka, Mizelle D’Silva, Ho‐Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Bjørn Edwin, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Rong Liu, Brian K. P. Goh, International robotic and laparoscopic liver resection study group investigators
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):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047]. CONCLUSIONS: This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.