Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients.

Autor:	Sijberden JP; Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Hoogteijling TJ; Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Aghayan D; The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway.; Department of Surgery, Ringerike Hospital, Vestre Viken Hospital Trust, Drammen, Norway., Ratti F; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy., Tan EK; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore., Morrison-Jones V; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Lanari J; Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Haentjens L; Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium., Wei K; Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China., Tzedakis S; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France., Martinie J; Department of Surgery, Division of HPB Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC., Osei Bordom D; Liver Unit, Queen Elizabeth Hospital, Birmingham, UK., Zimmitti G; Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy., Crespo K; Digestive Health Institute, AdventHealth Tampa, Tampa, FL., Magistri P; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy., Russolillo N; Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy., Conci S; Department of Surgery, University of Verona, Verona, Italy., Görgec B; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Benedetti Cacciaguerra A; Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy., D'Souza D; Department of Surgery, McMaster University, Hamilton, Ontario, Canada., Zozaya G; Department of Surgery, HPB and Liver Transplantation Unit, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain., Caula C; Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain., Geller D; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA., Robles Campos R; Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain., Croner R; Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany., Rehman S; Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK., Jovine E; Department of Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Efanov M; Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia., Alseidi A; Department of Surgery, Virginia Mason Medical Center, Seattle, WA.; Department of Surgery, University of California San Francisco, CA., Memeo R; Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy., Dagher I; Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Paris, France., Giuliante F; Chirurgia Epatobiliare, Università Cattolica del Sacro Cuore-IRCCS, Rome, Italy., Sparrelid E; Department for Clinical Science, Division of Surgery, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden., Ahmad J; University Hospitals Coventry and Warwickshire, Clifford Bridges Road, Coventry, UK., Gallagher T; St. Vincent's University Hospital, Elm Park, Dublin, Ireland., Schmelzle M; Department of General, Visceral and Transplant Surgery, Medizinische Hochschule Hannover, Hannover, Germany., Swijnenburg RJ; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Fretland ÅA; The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway., Cipriani F; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy., Koh YX; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore., White S; Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany., Lopez Ben S; Servei de Cirurgia General i Digestiva, Hospital Doctor Josep Trueta de Girona, Girona, Catalonia, Spain., Rotellar F; Department of Surgery, HPB and Liver Transplantation Unit, University Clinic, Universidad de Navarra, Institute of Health Research of Navarra (IdisNA), Pamplona, Spain., Serrano PE; Department of Surgery, McMaster University, Hamilton, Ontario, Canada., Vivarelli M; Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy., Ruzzenente A; Department of Surgery, University of Verona, Verona, Italy., Ferrero A; Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy., Di Benedetto F; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy., Besselink MG; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Sucandy I; Digestive Health Institute, AdventHealth Tampa, Tampa, FL., Sutcliffe RP; Liver Unit, Queen Elizabeth Hospital, Birmingham, UK., Vrochides D; Department of Surgery, Division of Abdominal Transplantation, Carolinas Medical Center, Atrium Health, Charlotte, NC., Fuks D; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France., Liu R; Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China., D'Hondt M; Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium., Cillo U; Department of Surgical, Oncological and Gastroenterological Sciences, General Surgery 2, Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Primrose JN; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Goh BKP; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore.; Surgery Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore., Aldrighetti LA; Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy., Edwin B; The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo, Oslo, Norway., Abu Hilal M; Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jul 01; Vol. 280 (1), pp. 108-117. Date of Electronic Publication: 2024 Mar 14.
DOI:	10.1097/SLA.0000000000006267
Abstrakt:	Objective: To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. Background: Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. Methods: In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. Results: Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. Conclusions: While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS. Competing Interests: M.A.H. and M.G.B. received grants from Medtronic GmbH, Intuitive Surgical Inc., and Johnson & Johnson Medical GmbH for investigator-initiated studies. S.L.B. reported received fees from Baxter, Olympus, and Johnson & Johnson. M.S. reported received fees from Merck Serono GmbH, Bayer AG, ERBE Elektromedizin GmbH, Amgen Inc., AstraZeneca, Avateramedical GmbH, Johnson & Johnson Medical GmbH, TakedaPharmaceutical Limited, Olympus K.K., Medtronic GmbH, Intuitive Surgical Inc., Corzamedical, Baxter Int Inc. A.A.F. reported speaker’s honoraria from Bayer and Olympus. F.R. reported speakers' honoraria from Olympus. The remaining authors report no conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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