倾向评分匹配和粗糙精确匹配分析比较机器人和腹腔镜肝切除术：4822 例国际多中心研究。
Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.
机构信息
The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Organ Transplantation Department, The Third Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
出版信息
Ann Surg. 2023 Dec 1;278(6):969-975. doi: 10.1097/SLA.0000000000005855. Epub 2023 Apr 14.
OBJECTIVE
To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH).
BACKGROUND
Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH.
METHODS
This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups.
RESULTS
A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047].
CONCLUSIONS
This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.
目的
比较机器人辅助肝切除术（R-MH）与腹腔镜肝切除术（L-MH）的结果。
背景
机器人技术可能克服腹腔镜肝切除术的局限性。然而，尚不清楚 R-MH 是否优于 L-MH。
方法
这是对 2008 年至 2021 年间在 59 个国际中心进行的 R-MH 或 L-MH 的多中心数据库的事后分析。收集并分析了患者人口统计学、中心经验量、围手术期结果和肿瘤特征的数据。为了最小化两组之间的选择偏差，同时进行了 1:1 倾向评分匹配（PSM）和粗化精确匹配（CEM）分析。
结果
共有 4822 例符合研究标准，其中 892 例接受 R-MH，3930 例接受 L-MH。均进行了 1:1 PSM（841 例 R-MH 与 841 例 L-MH）和 CEM（237 例 R-MH 与 356 例 L-MH）。R-MH 与明显较少的出血量相关{PSM：200.0（四分位距（IQR）：100.0，450.0）与 300.0（IQR：150.0，500.0）mL；P = 0.012；CEM：170.0（IQR：90.0，400.0）与 200.0（IQR：100.0，400.0）mL；P = 0.006}，较低的阻断肝门血流应用率（PSM：47.1%与 63.0%；P < 0.001；CEM：54.0%与 65.0%；P = 0.007）和开腹转化率（PSM：5.1%与 11.9%；P < 0.001；CEM：5.5%与 10.4%；P = 0.04）与 L-MH 相比。在 1273 例肝硬化患者的亚组分析中，R-MH 与较低的术后发病率相关（PSM：19.5%与 29.9%；P = 0.02；CEM：10.4%与 25.5%；P = 0.02）和较短的术后住院时间[PSM：6.9（IQR：5.0，9.0）天与 8.0（IQR：6.0，11.3）天；P < 0.001；CEM：7.0（IQR：5.0，9.0）天与 7.0（IQR：6.0，10.0）天；P = 0.047]。
结论
这项国际多中心研究表明，R-MH 在安全性方面与 L-MH 相当，并且与减少出血量、降低阻断肝门血流应用率和转为开腹手术相关。
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