Top

Published in:

Open Access 21-02-2023 | Hemangioma | Original Article

Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study

Authors: Wei Zhang, Junjie Liu, Zunyi Zhang, Yuwei Wang, Shuai Xiang, Lin Chen, Peng Zhu, Wanguang Zhang, Chang Shu, Wan Yee Lau, Bixiang Zhang, Xiaoping Chen

Published in: Surgical Endoscopy | Issue 6/2023

Abstract

Background

Minimally invasive techniques have increasingly been adopted for liver resection. This study aimed to compare the perioperative outcomes of robot-assisted liver resection (RALR) with laparoscopic liver resection (LLR) for liver cavernous hemangioma and to evaluate the treatment feasibility and safety.

Methods

A retrospective study of prospectively collected data was conducted on consecutive patients who underwent RALR (n = 43) and LLR (n = 244) for liver cavernous hemangioma between February 2015 and June 2021 at our institution. Patient demographics, tumor characteristics, and intraoperative and postoperative outcomes were analyzed and compared using propensity score matching.

Results

The postoperative hospital stay was significantly shorter (P = 0.016) in the RALR group. There were no significant differences between the two groups in overall operative time, intraoperative blood loss, blood transfusion rates, conversion to open surgery or complication rates. There was no perioperative mortality. Multivariate analysis showed that hemangiomas located in posterosuperior liver segments and those in close proximity to major vascular structures were independent predictors of increased intraoperative blood loss (P = 0.013 and P = 0.001, respectively). For patients with hemangioma in close proximity to major vascular structures, there were no significant differences in perioperative outcomes between the two groups, with the exception that intraoperative blood loss in the RALR group was significantly less than that in the LLR group (350 ml vs. 450 ml, P = 0.044).

Conclusions

Both RALR and LLR were safe and feasible for treating liver hemangioma in well-selected patients. For patients with liver hemangioma in close proximity to major vascular structures, RALR was better than conventional laparoscopic surgery in reducing intraoperative blood loss.

Reddy KR, Kligerman S, Levi J, Livingstone A, Molina E, Franceschi D, Badalamenti S, Jeffers L, Tzakis A, Schiff ER (2001) Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg 67:173–178PubMedCrossRef

Mergo PJ, Ros PR (1998) Benign lesions of the liver. Radiol Clin North Am 36:319–331PubMedCrossRef

Okano H, Shiraki K, Inoue H, Ito T, Yamanaka T, Deguchi M, Sugimoto K, Sakai T, Ohmori S, Murata K, Takase K, Nakano T (2001) Natural course of cavernous hepatic hemangioma. Oncol Rep 8:411–414PubMed

Pietrabissa A, Giulianotti P, Campatelli A, Di Candio G, Farina F, Signori S, Mosca F (1996) Management and follow-up of 78 giant haemangiomas of the liver. Br J Surg 83:915–918PubMedCrossRef

Pulvirenti E, Toro A, Di Carlo I (2010) An update on indications for treatment of solid hepatic neoplasms in noncirrhotic liver. Future Oncol 6:1243–1250PubMedCrossRef

Lerner SM, Hiatt JR, Salamandra J, Chen PW, Farmer DG, Ghobrial RM, Busuttil RW (2004) Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg 139:818–821PubMedCrossRef

Farges O, Daradkeh S, Bismuth H (1995) Cavernous hemangiomas of the liver: are there any indications for resection? World J Surg 19:19–24PubMedCrossRef

Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH, DeMatteo RP (2003) Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 197:392–402PubMedCrossRef

Giuliante F, Ardito F, Vellone M, Giordano M, Ranucci G, Piccoli M, Giovannini I, Chiarla C, Nuzzo G (2011) Reappraisal of surgical indications and approach for liver hemangioma: single-center experience on 74 patients. Am J Surg 201:741–748PubMedCrossRef

10.

Zhang W, Huang ZY, Ke CS, Wu C, Zhang ZW, Zhang BX, Chen YF, Zhang WG, Zhu P, Chen XP (2015) Surgical treatment of giant liver hemangioma larger than 10 cm: a single center’s experience with 86 patients. Medicine (Baltimore) 94:e1420PubMedCrossRef

11.

Gavriilidis P, Roberts KJ, Aldrighetti L, Sutcliffe RP (2020) A comparison between robotic, laparoscopic and open hepatectomy: a systematic review and network meta-analysis. Eur J Surg Oncol 46:1214–1224PubMedCrossRef

12.

Liu R, Wakabayashi G, Kim HJ, Choi GH, Yiengpruksawan A, Fong Y, He J, Boggi U, Troisi RI, Efanov M, Azoulay D, Panaro F, Pessaux P, Wang XY, Zhu JY, Zhang SG, Sun CD, Wu Z, Tao KS, Yang KH, Fan J, Chen XP (2019) International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol 25:1432–1444PubMedPubMedCentralCrossRef

13.

Schmelzle M, Krenzien F, Schöning W, Pratschke J (2020) Laparoscopic liver resection: indications, limitations, and economic aspects. Langenbecks Arch Surg 405:725–735PubMedPubMedCentralCrossRef

14.

Kitisin K, Packiam V, Bartlett DL, Tsung A (2011) A current update on the evolution of robotic liver surgery. Minerva Chir 66:281–293PubMed

15.

Muaddi H, Hafid ME, Choi WJ, Lillie E, de Mestral C, Nathens A, Stukel TA, Karanicolas PJ (2021) Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews. Ann Surg 273:467–473PubMedCrossRef

16.

Okumura Y, Noda T, Eguchi H, Hanaki T, Iwagami Y, Akita H, Asaoka T, Gotoh K, Kobayashi S, Umeshita K, Mori M, Doki Y (2019) Pure laparoscopic liver resection for giant liver hemangioma with extrahepatic growth based on preoperative 3-dimensional simulation: a case report. Surg Case Rep 5:51PubMedPubMedCentralCrossRef

17.

Kim IS, Kwon CH (2014) Feasibility of laparoscopic liver resection for giant hemangioma of greater than 6 cm in diameter. Korean J Hepatobiliary Pancreat Surg 18:118–121PubMedPubMedCentralCrossRef

18.

Veerankutty FH, Rather SA, Yeldho V, Zacharia BM, Tu SA, Venugopal B (2019) Totally laparoscopic resection of an extremely giant hepatic hemangioma. Surg J (N Y) 5:e110–e112PubMedCrossRef

19.

Giulianotti PC, Addeo P, Bianco FM (2011) Robotic right hepatectomy for giant hemangioma in a Jehovah’s witness. J Hepatobiliary Pancreat Sci 18:112–118PubMedCrossRef

20.

Giulianotti PC, Bustos R, Valle V, Aguiluz G, Pavelko Y, Fernandes E (2019) Robot-assisted enucleation of gigantic liver hemangiomas: case series of 3 patients. Int J Surg Case Rep 60:244–248PubMedPubMedCentralCrossRef

21.

Zhu P, Liao W, Ding ZY, Chen L, Zhang WG, Zhang BX, Chen XP (2019) Learning curve in robot-assisted laparoscopic liver resection. J Gastrointest Surg 23:1778–1787PubMedCrossRef

22.

Zhang W, Wang J, Li C, Zhang Z, Dirie NI, Dong H, Xiang S, Zhang W, Zhang Z, Zhang B, Chen X (2017) Infrahepatic inferior vena cava clamping with pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas. Surg Endosc 31:3628–3636PubMedPubMedCentralCrossRef

23.

Baer HU, Dennison AR, Mouton W, Stain SC, Zimmermann A, Blumgart LH (1992) Enucleation of giant hemangiomas of the liver. Technical and pathologic aspects of a neglected procedure. Ann Surg 216:673–676PubMedPubMedCentralCrossRef

24.

The Terminology Committee of the IHPBA (2000) The Brisbane 2000 terminology of hepatic anatomy and resections. HPB 2:333–339CrossRef

25.

Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMed

26.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentralCrossRef

27.

Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the international study group of liver surgery. Surgery 149:680–688PubMedCrossRef

28.

Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the international study group of liver surgery (ISGLS). Surgery 149:713–724PubMedCrossRef

29.

Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841PubMedCrossRef

30.

Shin Y, Rhu J, Choi GS, Kim JM, Joh JW, Kwon CHD (2020) Feasibility of laparoscopic liver resection for liver cavernous hemangioma: a single-institutional comparative study. Ann Hepatobiliary Pancreat Surg 24:137–143PubMedPubMedCentralCrossRef

31.

Liu Q, Liu F, Ding J, Wei Y, Li B (2019) Surgical outcomes and quality of life between laparoscopic and open approach for hepatic hemangioma: a propensity score matching analysis. Medicine (Baltimore) 98:14485CrossRef

32.

Xie QS, Chen ZX, Zhao YJ, Gu H, Geng XP, Liu FB (2021) Outcomes of surgery for giant hepatic hemangioma. BMC Surg 21(1):186PubMedPubMedCentralCrossRef

33.

Yu HB, Dong YD, Wang LC, Tian GJ, Mu SM, Cao Y, Peng YN, Lou CY, Liu P, Li DY (2015) Laparoscopic versus open resection for liver cavernous hemangioma: a single center of 2-year experience. Surg Laparosc Endosc Percutaneous Tech 25:e145-147CrossRef

34.

Hu M, Chen K, Zhang X, Li C, Song D, Liu R (2020) Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter. BMC Surg 20:93PubMedPubMedCentralCrossRef

35.

Montalti R, Berardi G, Patriti A, Vivarelli M, Troisi RI (2015) Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World J Gastroenterol 21:8441–8451PubMedPubMedCentralCrossRef

36.

Hu Y, Guo K, Xu J, Xia T, Wang T, Liu N, Fu Y (2021) Robotic versus laparoscopic hepatectomy for malignancy: a systematic review and meta-analysis. Asian J Surg 44:615–628PubMedCrossRef

37.

Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, Marsh W, Reddy SK, Bartlett DL (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555PubMedCrossRef

38.

Gedaly R, Pomposelli JJ, Pomfret EA, Lewis WD, Jenkins RL (1999) Cavernous hemangioma of the liver: anatomic resection vs enucleation. Arch Surg 134:407–411PubMedCrossRef

39.

Hamaloglu E, Altun H, Ozdemir A, Ozenc A (2005) Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg 29:890–893PubMedCrossRef

40.

Singh RK, Kapoor S, Sahni P, Chattopadhyay TK (2007) Giant haemangioma of the liver: is enucleation better than resection? Ann R Coll Surg Engl 89:490–493PubMedPubMedCentralCrossRef

41.

Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK, Jang JY, Choi H, Jang JS, Kwon SU (2016) Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: a case-matched analysis. Surgery 160:1219–1226PubMedCrossRef

42.

Zheng H, Huang SG, Qin SM, Xiang F (2019) Comparison of laparoscopic versus open liver resection for lesions located in posterosuperior segments: a meta-analysis of short-term and oncological outcomes. Surg Endosc 33:3910–3918PubMedCrossRef

43.

Hajibandeh S, Hajibandeh S, Dave M, Tarazi M, Satyadas T (2020) Laparoscopic versus open liver resection for tumors in the posterosuperior segments: a systematic review and meta-analysis. Surg Laparosc Endosc Percutaneous Tech 30:93–105CrossRef

44.

Tranchart H, Ceribelli C, Ferretti S, Dagher I, Patriti A (2014) Traditional versus robot-assisted full laparoscopic partial hepatectomy: a matched-pair comparative study. World J Surg 38:2904–2909PubMedCrossRef

45.

Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824PubMedCrossRef

46.

Montalti R, Scuderi V, Patriti A, Vivarelli M, Troisi RI (2016) Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30:1004–1013PubMedCrossRef

47.

Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38PubMedCrossRef

48.

Fu XH, Lai EC, Yao XP, Chu KJ, Cheng SQ, Shen F, Wu MC, Lau WY (2009) Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions? Am J Surg 198:184–187PubMedCrossRef

49.

Ho HY, Wu TH, Yu MC, Lee WC, Chao TC, Chen MF (2012) Surgical management of giant hepatic hemangiomas: complications and review of the literature. Chang Gung Med J 35:70–78PubMed

50.

Jinhuan Y, Gang D, Binyao S, Huan M, Bin J (2020) Is laparoscopic hepatectomy suitable for giant hepatic hemangioma larger than 10 cm in diameter? Surg Endosc 34(3):1224–1230PubMedCrossRef

51.

Ulas M, Ozer I, Bostancil EB, Karaman K, Dalgic T, Polatl E, Ercan M, Ozogul YB, Akoglul M (2014) Giant hemangiomas: effects of size and type of surgical procedure on postoperative outcome. Hepatogastroenterology 61:1297–1301PubMed

52.

Tsilimigras DI, Moris D, Vagios S, Merath K, Pawlik TM (2018) Safety and oncologic outcomes of robotic liver resections: a systematic review. J Surg Oncol 117:1517–1530PubMedCrossRef

53.

Aziz H, Wang JC, Genyk Y, Sheikh MR (2022) Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database. J Robot Surg 16:401–407PubMedCrossRef

54.

Murtha-Lemekhova A, Fuchs J, Hoffmann K (2022) Innovation for the sake of innovation? How does robotic hepatectomy compare to laparoscopic or open resection for HCC-A systematic review and meta-analysis. Cancers (Basel) 14:3359PubMedCrossRef

55.

Stiles ZE, Behrman SW, Glazer ES, Deneve JL, Dong L, Wan JY, Dickson PV (2017) Predictors and implications of unplanned conversion during minimally invasive hepatectomy: an analysis of the ACS-NSQIP database. HPB (Oxford) 19:957–965PubMedCrossRef

56.

Spampinato MG, Coratti A, Bianco L, Caniglia F, Laurenzi A, Puleo F, Ettorre GM, Boggi U (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28:2973–2979PubMedCrossRef

57.

Gheza F, Esposito S, Gruessner S, Mangano A, Fernandes E, Giulianotti PC (2019) Reasons for open conversion in robotic liver surgery: a systematic review with pooled analysis of more than 1000 patients. Int J Med Robot 15(2):e1976PubMedCrossRef

58.

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 (2022) Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy. JAMA Surg 157:436–444PubMedPubMedCentralCrossRef

59.

Sucandy I, Rayman S, Lai EC, Tang CN, Chong Y, Efanov M, Fuks D, Choi GH, Chong CC, Chiow AKH, Marino MV, Prieto M, Lee JH, Kingham TP, D'Hondt M, Troisi RI, Choi SH, Sutcliffe RP, Cheung TT, Rotellar F, Park JO, Scatton O, Han HS, Pratschke J, Wang X, Liu R, Goh BKP; International Robotic, Laparoscopic Liver Resection Study Group Investigators (2022) Robotic versus laparoscopic left and extended left hepatectomy: an international multicenter study propensity score-matched analysis. Ann Surg Oncol 29(13):8398–8406PubMedCrossRef

60.

Fagenson AM, Gleeson EM, Pitt HA, Lau KN (2021) Minimally invasive hepatectomy in North America: laparoscopic versus robotic. J Gastrointest Surg 25:85–93PubMedCrossRef

Title: Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study
Authors: Wei Zhang
Junjie Liu
Zunyi Zhang
Yuwei Wang
Shuai Xiang
Lin Chen
Peng Zhu
Wanguang Zhang
Chang Shu
Wan Yee Lau
Bixiang Zhang
Xiaoping Chen
Publication date: 21-02-2023
Publisher: Springer US
Keywords: Hemangioma
Liver Surgery
Liver Resection
Liver Surgery
Liver Resection
Hemangioma
Hemangioma
Hemangioma
Hemangioma
Published in: Surgical Endoscopy / Issue 6/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-022-09834-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative outcomes of robot-assisted versus laparoscopic liver resection for cavernous hemangioma: a propensity score matching study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2023

Unnecessary endoscopic retrograde cholangiopancreatography associated with the spontaneous passage of common bile duct stones into the duodenum: a multicenter retrospective study

Robotic diaphragm plication: functional and surgical outcomes of a single-center experience

High rate of stone-related complications after stapling the cystic duct during laparoscopic cholecystectomy—an underrecognized risk

Impact of the COVID-19 Pandemic on Inpatient and Outpatient Utilization of Bariatric Surgery

A self-selecting prophecy: prevalence of burnout in surgical fellows

Skill-qualified surgeons positively affect short-term outcomes after laparoscopic gastrectomy for gastric cancer: a survey of the National Clinical Database of Japan