Rayman Shlomi, Sucandy Iswanto, Ross Sharona B, Crespo Kaitlyn, Syblis Cameron, App Samantha, Rosemurgy Alexander
Department of General Surgery, 64850Assuta Medical Center, Israel.
4422Digestive Health Institute Tampa AdventHealth Tampa, Tampa, FL, USA.
Am Surg. 2022 Sep;88(9):2108-2114. doi: 10.1177/00031348221091476. Epub 2022 Apr 28.
This study was undertaken to examine the postoperative outcomes, costs, and survival after robotic hepatectomy for hepatocellular carcinoma (HCC) in patients with or without metabolic syndrome.
Following IRB approval, we prospectively followed 56 patients undergoing robotic hepatectomy for HCC from 2016-2020. Patients with metabolic syndrome were compared to patients without metabolic syndrome regarding postoperative clinical outcomes, costs, and survival. Propensity score matching of a 1:1 ratio matched patients with and without metabolic syndrome according to 6 variables.
17 patients were matched to each arm. Mean age was 64 ± 14.0 years and 30 patients (88%) had operations that were classified as advanced (IWATE 7-9) or expert (IWATE 10-12). There were no differences between patients with metabolic syndrome versus patients without metabolic syndrome in terms of operative duration (306 [301 ± 76.2] vs 239 [260 ± 116.9] minutes; P = 0.23), estimated blood loss (300 [321 ± 195.5] vs 200 [214 ± 151.4] ml; P = 0.08), conversion to "open" operation (1 [6%] vs 1 [6%]; p = 1.00), tumor size (5 [5 ± 3.0] vs 3 [4 ± 2.2] cm; P = 0.28), postoperative complications with Clavien-Dindo Score (≥III) (0 vs 1; P = 1.00), in-hospital mortality (0 [0%] vs 1 [6%]; P = 1.00), length of stay (5 [5 ± 1.7] vs 4 [5 ± 4.4] days; P = 1.00), and 30-day readmissions (1 [6%] vs 1 [6%]; P = 1.00). There were no differences in overall costs and profit. There was no difference in 1-year, 2-year, and 3- year overall survival in patients with or without metabolic syndrome after robotic HCC resection (84% vs 77%, 84% vs 61%, and 45% vs 61%, P = 0.42).
For patients with and without metabolic syndrome, robotic advanced/expert hepatectomy for HCC resulted in similar intra-operative metrics, postoperative outcomes, costs, and survival.
本研究旨在探讨代谢综合征患者与非代谢综合征患者行机器人肝癌切除术（HCC）后的术后结局、成本及生存率。
经机构审查委员会（IRB）批准后，我们前瞻性地随访了2016年至2020年期间接受机器人肝癌切除术的56例患者。将代谢综合征患者与非代谢综合征患者在术后临床结局、成本和生存率方面进行比较。根据6个变量对代谢综合征患者与非代谢综合征患者进行1:1倾向评分匹配。
每组匹配17例患者。平均年龄为64±14.0岁，30例患者（88%）的手术被分类为高级（岩手7-9级）或专家级（岩手10-12级）。代谢综合征患者与非代谢综合征患者在手术时间（306[301±76.2]分钟vs239[260±116.9]分钟；P=0.23）、估计失血量（300[321±195.5]ml vs200[214±151.4]ml；P=0.08）、转为“开放”手术（1例[6%]vs1例[6%]；p=1.00）、肿瘤大小（5[5±3.0]cm vs3[4±2.2]cm；P=0.28）、Clavien-Dindo评分≥III级的术后并发症（0例vs1例；P=1.00）、住院死亡率（0例[0%]vs1例[6%]；P=1.00）、住院时间（5[5±1.7]天vs4[5±4.4]天；P=1.00）及30天再入院率（1例[6%]vs1例[6%]；P=1.00）方面均无差异。总成本和利润也无差异。机器人肝癌切除术后，代谢综合征患者与非代谢综合征患者的1年、2年和3年总生存率无差异（84%vs77%、84%vs61%、45%vs61%，P=0.42）。
对于代谢综合征患者与非代谢综合征患者，机器人肝癌高级/专家级切除术的术中指标、术后结局、成本及生存率相似。
