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01-06-2019 | Liver Resection | Original Scientific Report

Short- and Long-term Outcomes after Robotic and Laparoscopic Liver Resection for Malignancies: A Propensity Score-Matched Study

Authors: Chetana Lim, Chady Salloum, Antonella Tudisco, Claudio Ricci, Michael Osseis, Niccolo Napoli, Eylon Lahat, Ugo Boggi, Daniel Azoulay

Published in: World Journal of Surgery | Issue 6/2019

Abstract

Objectives

A laparoscopic approach improves short-term outcomes and maintains long-term outcomes compared to an open approach. In turn, the recent development of robotic surgery raises the question whether it performs as well as laparoscopic surgery. The aim of this study was to compare the short- and long-term outcomes of laparoscopic liver resection (LLR) and robotic liver resection (RLR) for malignancies.

Method

From 2011 to 2017, the study population included 111 patients in the LLR group and 61 in the RLR group. Short- and long-term outcomes were compared before and after propensity score matching (PSM).

Results

Operative mortality rate was nil. The intraoperative blood transfusion rate was higher during RLR (15% vs. 2%, p = 0.0009). Major morbidity and hospital stay were not different between the two groups. The resection margin width (LLR 7 mm vs. RLR 10 mm, p = 0.13) and R1 resection rates (resection margin width < 1 mm; LLR 15% vs. RLR 11%, p = 0.49) were similar. After PSM (55 patients in each group), the blood transfusion, major morbidity, hospital stay and R1 resection were similar between the two groups. When considering the largest subset of patients with hepatocellular carcinoma including 114 patients (66%), the 3-year overall survival rate was 80% in the LLR group and 97% in the RLR group (p = 0.10) and remained similar after PSM (p = 0.27). The 3-year recurrence-free survival rate was 50% in the LLR group and 64% in the RLR group (p = 0.30) and remained similar after PSM (p = 0.26).

Conclusions

No differences were found in blood transfusion, incidence of positive resection margins and long-term outcomes between the two techniques. RLR does not compromise short-term and oncologic outcomes in patients with liver cancers.

Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250(5):825–830CrossRefPubMed

Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629PubMed

Doussot A, Lim C, Lahat E et al (2017) Complications after hepatectomy for hepatocellular carcinoma independently shorten survival: a western, single-center audit. Ann Surg Oncol 24(6):1569–1578CrossRefPubMed

Kawai T, Goumard C, Jeune F et al (2018) Laparoscopic liver resection for colorectal liver metastasis patients allows patients to start adjuvant chemotherapy without delay: a propensity score analysis. Surg Endosc 32(7):3273–3281CrossRefPubMed

Efanov M, Alikhanov R, Tsvirkun V et al (2017) Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB (Oxford) 19(9):818–824CrossRef

Salloum C, Lim C, Lahat E et al (2016) Robotic-assisted versus laparoscopic left lateral sectionectomy: analysis of surgical outcomes and costs by a propensity score matched cohort study. World J Surg 41(2):516–524. https://doi.org/10.1007/s00268-016-3736-2 CrossRef

Berber E, Akyildiz HY, Aucejo F et al (2010) Robotic versus laparoscopic resection of liver tumours. HPB (Oxford) 12(8):583–586CrossRef

Ji WB, Wang HG, Zhao ZM et al (2010) Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg 253(2):342–348CrossRef

Packiam V, Bartlett DL, Tohme S et al (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 16(12):2233–2238CrossRefPubMedPubMedCentral

10.

Troisi RI, Patriti A, Montalti R, Casciola L (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot 9(2):160–166CrossRefPubMed

11.

Wu YM, Hu RH, Lai HS, Lee PH (2014) Robotic-assisted minimally invasive liver resection. Asian J Surg 37(2):53–57CrossRefPubMed

12.

Yu YD, Kim KH, Jung DH et al (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg 399(8):1039–1045CrossRefPubMed

13.

Spampinato MG, Coratti A, Bianco L et al (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28(10):2973–2979CrossRefPubMed

14.

Tsung A, Geller DA, Sukato DC et al (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555CrossRefPubMed

15.

Tranchart H, Ceribelli C, Ferretti S et al (2014) Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg 38(11):2904–2909. https://doi.org/10.1007/s00268-014-2679-8 CrossRefPubMed

16.

Montalti R, Scuderi V, Patriti A et al (2015) Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30(3):1004–1013CrossRefPubMed

17.

Lai EC, Tang CN (2016) Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Tech 26(2):162–166CrossRefPubMed

18.

Croner RS, Perrakis A, Hohenberger W, Brunner M (2016) Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg 401(5):707–714CrossRefPubMed

19.

Lee KF, Cheung YS, Chong CC et al (2016) Laparoscopic and robotic hepatectomy: experience from a single centre. ANZ J Surg 86(3):122–126CrossRefPubMed

20.

Kim JK, Park JS, Han DH et al (2016) Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc 30(11):4756–4764CrossRefPubMed

21.

Magistri P, Tarantino G, Guidetti C et al (2017) Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases. J Surg Res 217:92–99CrossRefPubMed

22.

Salloum C, Subar D, Memeo R et al (2014) Laparoscopic robotic liver surgery: the Henri Mondor initial experience of 20 cases. J Robot Surg 8(2):119–124CrossRefPubMed

23.

Lim C, Osseis M, Lahat E et al (2018) Extracorporeal pringle maneuver during laparoscopic and robotic hepatectomy: detailed technique and first comparison with intracorporeal maneuver. J Am Coll Surg 226(5):e19–e25CrossRefPubMed

24.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRef

25.

Lonjon G, Porcher R, Ergina P et al (2016) Potential pitfalls of reporting and bias in observational studies with propensity score analysis assessing a surgical procedure: a methodological systematic review. Ann Surg 265(5):901–909CrossRef

26.

Gomez-Gavara C, Doussot A, Lim C et al (2017) Impact of intraoperative blood transfusion on short and long term outcomes after curative hepatectomy for intrahepatic cholangiocarcinoma: a propensity score matching analysis by the AFC-IHCC study group. HPB (Oxford) 19(5):411–420CrossRef

27.

Lyu X, Qiao W, Li D, Leng Y (2017) Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis. Oncotarget 8(25):41740–41748CrossRefPubMedPubMedCentral

28.

Postlewait LM, Squires MH 3rd, Kooby DA et al (2016) The relationship of blood transfusion with peri-operative and long-term outcomes after major hepatectomy for metastatic colorectal cancer: a multi-institutional study of 456 patients. HPB (Oxford) 18(2):192–199CrossRef

29.

Kuroda S, Tashiro H, Kobayashi T et al (2012) No impact of perioperative blood transfusion on recurrence of hepatocellular carcinoma after hepatectomy. World J Surg 36(3):651–658. https://doi.org/10.1007/s00268-012-1425-3 CrossRefPubMed

30.

Khan S, Beard RE, Kingham PT et al (2018) Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann Surg Oncol 25(9):2652–2660. https://doi.org/10.1245/s10434-018-6629-9 CrossRefPubMed

Title: Short- and Long-term Outcomes after Robotic and Laparoscopic Liver Resection for Malignancies: A Propensity Score-Matched Study
Authors: Chetana Lim
Chady Salloum
Antonella Tudisco
Claudio Ricci
Michael Osseis
Niccolo Napoli
Eylon Lahat
Ugo Boggi
Daniel Azoulay
Publication date: 01-06-2019
Publisher: Springer International Publishing
Keywords: Liver Resection
Liver Resection
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: World Journal of Surgery / Issue 6/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-04927-x

At a glance: The STEP trials

Springer Medicine

Short- and Long-term Outcomes after Robotic and Laparoscopic Liver Resection for Malignancies: A Propensity Score-Matched Study

Abstract

Objectives

Method

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Method

Results

Conclusions

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