Patriti Alberto, Cipriani Federica, Ratti Francesca, Bartoli Alberto, Ceccarelli Graziano, Casciola Luciano, Aldrighetti Luca
Department of Surgery, Division of General, Minimally Invasive and Robotic Surgery, ASL Umbria Hospital San Matteo degli Infermi.
Department of Surgery, Hepatobiliary Unit, San Raffaele Scientific Institute, Milan, Italy.
JSLS. 2014 Jul-Sep;18(3). doi: 10.4293/JSLS.2014.00040.
Open liver resection is the current standard of care for lesions in the right posterior liver section. The objective of this study was to determine the safety of robot-assisted liver resection for lesions located in segments 6 and 7 in comparison with open surgery.
Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent open and robot-assisted liver resection at 2 centers for lesions in the right posterior section between January 2007 and June 2012 were reviewed. A 1:3 matched analysis was performed by individually matching patients in the robotic cohort to patients in the open cohort on the basis of demographics, comorbidities, performance status, tumor stage, and location.
Matched patients undergoing robotic and open liver resections displayed no significant differences in postoperative outcomes as measured by blood loss, transfusion rate, hospital stay, overall complication rate (15.8% vs 13%), R0 negative margin rate, and mortality. Patients undergoing robotic liver surgery had significantly longer operative time (mean, 303 vs 233 minutes) and inflow occlusion time (mean, 75 vs 29 minutes) compared with their open counterparts.
Robotic and open liver resections in the right posterior section display similar safety and feasibility.
开放性肝切除术是目前右后肝段病变的标准治疗方法。本研究的目的是比较机器人辅助肝切除术与开放性手术治疗位于第6和第7肝段病变的安全性。
回顾了2007年1月至2012年6月期间在2个中心接受开放性和机器人辅助肝切除术治疗右后段病变患者的人口统计学、合并症、临床病理特征、手术治疗及预后情况。基于人口统计学、合并症、体能状态、肿瘤分期和位置,对机器人手术组的患者与开放性手术组的患者进行个体匹配,进行1:3匹配分析。
接受机器人辅助肝切除术和开放性肝切除术的匹配患者在术后结果方面无显著差异,如出血量、输血率、住院时间、总体并发症发生率(15.8%对13%)、R0切缘阴性率和死亡率。与接受开放性肝手术的患者相比,接受机器人肝手术的患者手术时间显著更长(平均303分钟对233分钟),入肝血流阻断时间显著更长(平均75分钟对29分钟)。
右后段机器人辅助肝切除术和开放性肝切除术具有相似的安全性和可行性。