Publicaciones científicas
Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments: An International Multi-Center Study
Felix Krenzien 1 , Moritz Schmelzle 1 , Johann Pratschke 1 , Linda Feldbrügge 1 , Rong Liu 2 , Qu Liu 2 , Wanguang Zhang 3 , Joseph J Zhao 4 , Hwee-Leong Tan 4 , Federica Cipriani 5 , Tijs J Hoogteijling 6 , Davit L Aghayan 7 , Åsmund Avdem Fretland 7 , Tiing Foong Siow 8 , Chetana Lim 9 , Olivier Scatton 9 , Paulo Herman 10 , Fabricio Ferreira Coelho 10 , Marco V Marino 11 , Vincenzo Mazzaferro 12 , Adrian K H Chiow 13 , Iswanto Sucandy 14 , Arpad Ivanecz 15 , Sung Hoon Choi 16 , Jae Hoon Lee 17 , Mikel Gastaca 18 , Marco Vivarelli 19 , Felice Giuliante 20 , Bernardo Dalla Valle 21 , Andrea Ruzzenente 21 , Chee-Chien Yong 22 , Zewei Chen 23 , Mengqiu Yin 23 , Constantino Fondevila 24 , Mikhail Efanov 25 , Zenichi Morise 26 , Fabrizio Di Benedetto 27 , Raffaele Brustia 28 , Raffaele Dalla Valle 29 , Ugo Boggi 30 , David Geller 31 , Andrea Belli 32 , Riccardo Memeo 33 , Salvatore Gruttadauria 34 , Alejandro Mejia 35 , James O Park 36 , Fernando Rotellar 37 , Gi-Hong Choi 38 , Ricardo Robles-Campos 39 , Xiaoying Wang 40 , Robert P Sutcliffe 41 , Kiyoshi Hasegawa 42 , Chung-Ngai Tang 43 , Charing C N Chong 44 , Kit-Fai Lee 44 , Juul Meurs 45 , Mathieu D'Hondt 45 , Kazuteru Monden 46 , Santiago Lopez-Ben 47 , T Peter Kingham 48 , Alessandro Ferrero 49 , Giuseppe Maria Ettorre 50 , Franco Pascual 51 , Daniel Cherqui 51 , Junhao Zheng 52 , Xiao Liang 52 , Olivier Soubrane 53 , Go Wakabayashi 54 , Roberto I Troisi 55 , Tan-To Cheung 56 , Yutaro Kato 57 , Atsushi Sugioka 57 , Safi Dokmak 58 , Mizelle D'Silva 59 , Ho-Seong Han 59 , Phan Phuoc Nghia 60 , Tran Cong Duy Long 60 , Mohammad Abu Hilal 6 61 , Kuo-Hsin Chen 8 , David Fuks 53 , Luca Aldrighetti 5 , Bjørn Edwin 7 , Brian K P Goh 4 62 ; International robotic and laparoscopic liver resection study group investigators
Objective: To compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.
Background: Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in existing literature.
Methods: This is a post hoc analysis of a multicenter database of 5,446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumour features and perioperative characteristics were collected and analysed. Propensity score matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.
Results: A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%) and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate (10 of 449 [2.2%] vs. 54 of 898 [6.0%]; P=0.002), less blood loss (100 mL [IQR; 50-200] days vs. 150 mL [IQR; 50-350]; P<0.001) and a shorter operative time (188 min [IQR; 140-270] vs. 222 min [IQR; 158-300]; P<0.001). These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis - lower open conversion rate (1 of 136 [0.7%] vs. 17 of 272 [6.2%]; P=0.009), less blood loss (100 mL [IQR; 48-200] vs. 160 mL [IQR; 50-400]; P<0.001) and shorter operative time (190 min [IQR; 141-258] vs. 230 min [IQR; 160-312]; P=0.003). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.
Conclusion: RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss and open conversion rate when compared to LLLR.
CITA DEL ARTÍCULO Ann Surg. 2023 Jul 24. doi: 10.1097/SLA.0000000000006027
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