Yang Hye Yeon, Rho Seoung Yoon, Han Dai Hoon, Choi Jin Sub, Choi Gi Hong
Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2021 Feb 28;25(1):8-17. doi: 10.14701/ahbps.2021.25.1.8.
BACKGROUNDS/AIMS: Laparoscopic major liver resections are still considered innovative procedures despite the recent development of laparoscopic liver surgery. Robotic surgery has been introduced as an innovative system for laparoscopic surgery. In this study, we investigated surgical outcomes after major liver resections using robotic systems.
From January 2009 to October 2018, 70 patients underwent robotic major liver resections, which included conventional major liver resections and right sectionectomy. The short-term and long-term outcomes were compared with 252 open major resections performed during the same period.
Operative time was longer in the robotic group (472 min vs. 349 min, <0.001). However, estimated blood loss was lower in the robotic group compared with the open resection group (269 ml vs. 548 ml, =0.009). The overall postoperative complication rate of the robotic group was lower than that of the open resection group (31.4% vs. 58.3%, <0.001), but the major complication rate was similar between the two groups. Hospital stay was shorter in the robotic group (9.5 days vs. 15.1 days, =0.006). Among patients with HCC, cholangiocarcinoma, and colorectal liver metastasis, there was no difference in overall and disease-free survival between the two groups. After propensity score matching in 37 patients with HCC for each group, the robotic group still showed a shorter hospital stay and comparable long-term outcomes.
Robotic major liver resections provided improved perioperative outcomes and comparable long-term oncologic outcome compared with open resections. Therefore, robotic surgery should be considered one of the options for minimally invasive major liver resections.
背景/目的：尽管腹腔镜肝脏手术近年来有所发展，但腹腔镜大肝切除术仍被视为创新手术。机器人手术已作为一种腹腔镜手术的创新系统被引入。在本研究中，我们调查了使用机器人系统进行大肝切除术后的手术结果。
2009年1月至2018年10月，70例患者接受了机器人辅助大肝切除术，包括传统大肝切除术和右半肝切除术。将短期和长期结果与同期进行的252例开放性大肝切除术进行比较。
机器人组的手术时间较长（472分钟对349分钟，<0.001）。然而，机器人组的估计失血量低于开放性切除组（269毫升对548毫升，=0.009）。机器人组的总体术后并发症发生率低于开放性切除组（31.4%对58.3%，<0.001），但两组的主要并发症发生率相似。机器人组的住院时间较短（9.5天对15.1天，=0.006）。在肝癌、胆管癌和结直肠癌肝转移患者中，两组的总生存率和无病生存率无差异。在每组37例肝癌患者进行倾向评分匹配后，机器人组的住院时间仍然较短，长期结果相当。
与开放性切除术相比，机器人辅助大肝切除术改善了围手术期结果，长期肿瘤学结果相当。因此，机器人手术应被视为微创大肝切除术的选择之一。
