Medical School of Chinese PLA, Beijing, 100853, China.
Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
BMC Surg. 2023 Jun 7;23(1):153. doi: 10.1186/s12893-023-02058-8.
Robotic hepatectomy (RH) has gradually been accepted as it has overcome some of the limitations of open hepatectomy (OH). This study was to compare short-term outcomes in RH and OH for overweight (preoperative body mass index ≥ 25 kg/m²) patients with hepatocellular carcinoma (HCC).
Perioperative and postoperative data from these patients who underwent RH or OH between January 2010 and December 2020 were retrospectively analyzed. Propensity score matching (PSM) analysis was performed to determine the impact of RH versus OH on the prognosis of overweight HCC patients.
All 304 overweight HCC patients were included, 172 who were underwent RH, and 132 who were underwent OH. After the 1:1 PSM, there were 104 patients in both RH and OH groups. After PSM, the RH group of patients had a shorter operative time, less estimated blood loss (EBL), a longer total clamping time, a shorter postoperative length of stay (LOS), less chance of surgical site infection and less rates of blood transfusion (all P < 0.05) compared to the OH patients. The differences between operative time, EBL and LOS were more significant in obese patients. RH was found to be an independent protective factor of EBL ≥ 400ml relative to OH in overweight patients for the first time.
RH was safe and feasible in overweight HCC patients. Compared with OH, RH has advantages in terms of operative time, EBL, postoperative LOS, and surgical site infection. Carefully selected overweight patients should be considered for RH.
机器人肝切除术 (RH) 逐渐被接受，因为它克服了开腹肝切除术 (OH) 的一些局限性。本研究旨在比较 RH 和 OH 治疗超重 (术前体质量指数≥25kg/m²) 肝细胞癌 (HCC) 患者的短期疗效。
回顾性分析 2010 年 1 月至 2020 年 12 月期间接受 RH 或 OH 的超重 HCC 患者的围手术期和术后数据。采用倾向评分匹配 (PSM) 分析来确定 RH 与 OH 对超重 HCC 患者预后的影响。
共纳入 304 例超重 HCC 患者，其中 172 例行 RH，132 例行 OH。经过 1:1 PSM 后，RH 和 OH 组各有 104 例患者。PSM 后，与 OH 组相比，RH 组患者的手术时间更短，估计出血量 (EBL) 更少，总阻断时间更长，术后住院时间 (LOS) 更短，手术部位感染的机会更少，输血率更低（均 P<0.05）。肥胖患者的手术时间、EBL 和 LOS 的差异更为显著。首次发现 RH 是超重患者 EBL≥400ml 相对于 OH 的独立保护因素。
RH 对超重 HCC 患者是安全可行的。与 OH 相比，RH 在手术时间、EBL、术后 LOS 和手术部位感染方面具有优势。对于超重患者，应慎重选择 RH。
