Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 N Broad Street, Philadelphia, PA, 19140, USA.
Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA.
J Gastrointest Surg. 2021 Jan;25(1):85-93. doi: 10.1007/s11605-020-04703-6. Epub 2020 Jun 24.
Minimally invasive hepatectomy has been shown to be associated with improved outcomes when compared with open surgery. However, data comparing laparoscopic and robotic hepatectomy is lacking and limited to single-center studies.
Patients undergoing major (≥ 3 segments) or partial (≤ 2 segments) hepatectomy were identified in the 2014-2017 ACS-NSQIP hepatectomy targeted database. Patients undergoing laparoscopic and robotic approaches were compared, and propensity score matching was utilized to adjust for bias.
Of 3152 minimally invasive hepatectomies (MIHs), 86% (N = 2706) were partial and 14% (N = 446) were major. The laparoscopic approach was utilized in 92% of patients (N = 2905) and 8% were performed robotically (N = 247). The percentage of MIHs increased over time (p < 0.01). After matching, 240 were identified in each cohort. Compared with the robotic approach, patients undergoing laparoscopic hepatectomy had a significantly higher conversion rate (23% vs. 7.4%) but had shorter operative time (159 vs. 204 min) (p < 0.001). Laparoscopic cases undergoing an unplanned conversion to open were associated with increased morbidity (p < 0.001), but this difference was not observed in robotic cases. Both MIH approaches had low mortality (1.0%, p = 1.00), overall morbidity (17%, p = 0.47), and very short length of stay (3 days, p = 0.80).
Minimally invasive hepatectomy is performed primarily for partial hepatectomies. Laparoscopic hepatectomy is associated with a significantly higher conversion rate, and converted cases have worse outcomes. Both minimally invasive approaches are safe with similar mortality, morbidity, and a very short length of stay. Graphical Abstract.
与开放手术相比，微创肝切除术已被证明可带来更好的结果。然而，缺乏腹腔镜和机器人肝切除术的数据，且这些数据仅限于单中心研究。
在 2014-2017 年 ACS-NSQIP 肝切除术靶向数据库中确定接受主要（≥3 个节段）或部分（≤2 个节段）肝切除术的患者。比较腹腔镜和机器人方法，并利用倾向评分匹配来调整偏差。
在 3152 例微创肝切除术（MIHs）中，92%（N=2706）为部分切除术，14%（N=446）为主要切除术。92%的患者（N=2905）采用腹腔镜方法，8%的患者（N=247）采用机器人方法。MIHs 的比例随时间增加（p<0.01）。匹配后，每个队列各有 240 例。与机器人方法相比，接受腹腔镜肝切除术的患者中转开腹率显著更高（23%比 7.4%），但手术时间更短（159 比 204 分钟）（p<0.001）。腹腔镜手术中计划外中转开腹与更高的发病率相关（p<0.001），但机器人手术中未观察到这种差异。两种 MIH 方法的死亡率均很低（1.0%，p=1.00）、总发病率（17%，p=0.47）和住院时间极短（3 天，p=0.80）。
微创肝切除术主要用于部分肝切除术。腹腔镜肝切除术与更高的中转开腹率相关，中转开腹病例的结局更差。两种微创方法均安全，死亡率、发病率相似，住院时间极短。
