Salloum Chady, Lim Chetana, Lahat Eylon, Gavara Concepcion Gomez I, Levesque Eric, Compagnon Philippe, Azoulay Daniel
Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Henri Mondor Hospital, 51 Avenue De Lattre De Tassigny, 94010, Créteil, France.
Department of Anesthesia and Liver Intensive Care Unit, AP-HP Henri Mondor Hospital, Créteil, France.
World J Surg. 2017 Feb;41(2):516-524. doi: 10.1007/s00268-016-3736-2.
After comparing with open approach, left lateral sectionectomy (LLS) has become standard in terms of short-term outcomes without jeopardizing long-term survival when performed for malignancy. The aim of this study was to compare the short-term and economic outcomes of laparoscopic (L-LLS) and robotic (R-LLS) LLS.
All consecutive patients who underwent L-LLS or R-LLS from 1997 to 2014 were analyzed. Short-term and economic outcomes were compared between the two groups using a propensity score matching (PSM).
Ninety-six consecutive cases of LLS were performed using the laparoscopic (80 cases; 83 %) or robotic (16 cases; 17 %) approach. The two groups were similar for operative and surgical outcomes. Operation time was similar in the R-LLS compared to the L-LLS group (190 vs. 162 min; p = 0.10). Perioperative costs were higher (1457 € vs. 576 €; p < 0.0001) in the R-LLS group than in the L-LLS group; however, postoperative costs were similar between the two groups (4065 € in the R-LLS group vs. 5459 € in the L-LLS group; p = 0.30). Total costs were similar between the two groups (5522 € in the R-LLS group vs. 6035€ in the L-LLS group; p = 0.70). The PSM included 14 patients for each group. Surgical and economic outcomes remained similar after PSM, except for total operating time which was significantly longer in the R-LLS group than in the L-LLS group.
Even if feasible and safe, the robotic approach does not seem so far to offer additional benefit in terms of intra- and postoperative outcomes over the laparoscopic approach in patients requiring LLS. Total costs associated with the R-LLS group are not greater than that associated with the L-LLS group, which is the standard of care so far.
与开放手术相比，左侧肝段切除术（LLS）在治疗恶性肿瘤时，就短期疗效而言已成为标准术式，且不影响长期生存率。本研究旨在比较腹腔镜下左侧肝段切除术（L-LLS）和机器人辅助左侧肝段切除术（R-LLS）的短期疗效和经济成本。
分析1997年至2014年间所有连续接受L-LLS或R-LLS手术的患者。采用倾向评分匹配法（PSM）比较两组的短期疗效和经济成本。
连续96例LLS手术采用腹腔镜手术（80例；83%）或机器人辅助手术（16例；17%）。两组的手术和外科疗效相似。R-LLS组的手术时间与L-LLS组相似（190分钟对162分钟；p = 0.10）。R-LLS组的围手术期成本高于L-LLS组（1457欧元对576欧元；p < 0.0001）；然而，两组的术后成本相似（R-LLS组为4065欧元，L-LLS组为5459欧元；p = 0.30）。两组的总成本相似（R-LLS组为5522欧元，L-LLS组为6035欧元；p = 0.70）。PSM每组纳入14例患者。PSM后手术和经济成本仍相似，但R-LLS组的总手术时间显著长于L-LLS组。
即使机器人辅助手术可行且安全，但就LLS患者的术中和术后疗效而言，与腹腔镜手术相比，目前似乎并未带来额外益处。R-LLS组的总成本不高于L-LLS组，而L-LLS组是目前的标准治疗方式。
