Iswanto Sucandy1, Shlomi Rayman1, Eric C Lai2, Chung-Ngai Tang2, Yvette Chong3, Mikhail Efanov4, David Fuks5, Gi-Hong Choi6, Charing C Chong7, Adrian K H Chiow8, Marco V Marino9,10, Mikel Prieto11, Jae-Hoon Lee12, T Peter Kingham13, Mathieu D'Hondt14, Roberto I Troisi15, Sung Hoon Choi16, Robert P Sutcliffe17, Tan-To Cheung18, Fernando Rotellar19,20, James O Park21, Olivier Scatton22, Ho-Seong Han23, Johann Pratschke24, Xiaoying Wang25, Rong Liu26, Brian K P Goh27,28. 1. AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA. 2. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China. 3. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Ministry of Health Holdings Singapore, Singapore, Singapore. 4. Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia. 5. Department of Digestive, Oncologic, and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France. 6. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 7. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China. 8. Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore, Singapore. 9. General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. 10. Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy. 11. Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain. 12. Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 13. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 14. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium. 15. Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy. 16. Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea. 17. Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. 18. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China. 19. HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain. 20. Institute of Health Research of Navarra (IdisNA), Pamplona, Spain. 21. Department of Surgery, University of Washington Medical Center and Fred Hutchinson Cancer Center, Seattle, WA, USA. 22. Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France. 23. Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea. 24. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany. 25. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China. 26. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China. 27. Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore. bsgkp@hotmail.com. 28. Duke-National University of Singapore Medical School, Singapore, Singapore. bsgkp@hotmail.com.
Abstract
BACKGROUND: Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database. METHODS: An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade. RESULTS: Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009). CONCLUSION: Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.
BACKGROUND: Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database. METHODS: An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade. RESULTS: Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009). CONCLUSION: Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.
Authors: Hye Yeon Yang; Gi Hong Choi; Ken-Min Chin; Sung Hoon Choi; Nicholas L Syn; Tan-To Cheung; Adrian K H Chiow; Iswanto Sucandy; Marco V Marino; Mikel Prieto; Charing C Chong; Jae Hoon Lee; Mikhail Efanov; T Peter Kingham; Robert P Sutcliffe; Roberto I Troisi; Johann Pratschke; Xiaoying Wang; Mathieu D'Hondt; Chung Ngai Tang; Rong Liu; James O Park; Fernando Rotellar; Olivier Scatton; Atsushi Sugioka; Tran Cong Duy Long; Chung-Yip Chan; David Fuks; Ho-Seong Han; Brian K P Goh Journal: Br J Surg Date: 2022-03-15 Impact factor: 6.939
Authors: Ioannis A Ziogas; Dimitrios Giannis; Stepan M Esagian; Konstantinos P Economopoulos; Samer Tohme; David A Geller Journal: Surg Endosc Date: 2020-09-28 Impact factor: 4.584
Authors: Laura Alaimo; Zorays Moazzam; Zachary J Brown; Yutaka Endo; Andrea Ruzzenente; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Feng Shen; Olivier Soubrane; Bas Groot Koerkamp; Itaru Endo; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2022-08-27 Impact factor: 4.339