Publicaciones científicas

Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches

14-oct-2022 | Revista: British Journal of Surgery

Mizelle D'Silva  1 , Ho-Seong Han  1 , Rong Liu  2 , Thomas Peter Kingham  3 , Gi-Hong Choi  4 , Nicholas Li-Xun Syn  5 , Mikel Prieto  6 , Sung-Hoon Choi  7 , Iswanto Sucandy  8 , Adrian Kah Heng Chiow  9 , Marco Vito Marino  10 , Mikhail Efanov  11 , Jae-Hoon Lee  12 , Robert Peter Sutcliffe  13 , Charing Ching Ning Chong  14 , Chung-Ngai Tang  15 , Tan-To Cheung  16 , Johann Pratschke  17 , Xiaoying Wang  18 , James Oh Park  19 , Chung Yip Chan  20 , Olivier Scatton  21 , Fernando Rotellar  22 , Roberto Ivan Troisi  23 , Mathieu D'Hondt  24 , David Fuks  25 , Brian Kim Poh Goh  20 , international robotic and laparoscopic liver resection study group investigators


Background: Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).

Methods: This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.

Results: Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40-200) versus 200 (100-500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20-46) versus 40 (25-58) min; P = 0.012), and median duration of operation (175 (130-255) versus 224 (155-300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.

Conclusion: Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.

CITA DEL ARTÍCULO  Br J Surg. 2022 Oct 14;109(11):1140-1149.  doi: 10.1093/bjs/znac270