Krenzien Felix, Schmelzle Moritz, Pratschke Johann, Feldbrügge Linda, Liu Rong, Liu Qu, Zhang Wanguang, Zhao Joseph J, Tan Hwee-Leong, Cipriani Federica, Hoogteijling Tijs J, Aghayan Davit L, Fretland Åsmund A, Siow Tiing Foong, Lim Chetana, Scatton Olivier, Herman Paulo, Coelho Fabricio F, Marino Marco V, Mazzaferro Vincenzo, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Choi Sung Hoon, Lee Jae Hoon, Gastaca Mikel, Vivarelli Marco, Giuliante Felice, Dalla Valle Bernardo, Ruzzenente Andrea, Yong Chee-Chien, Chen Zewei, Yin Mengqiu, Fondevila Constantino, Efanov Mikhail, Morise Zenichi, Di Benedetto Fabrizio, Brustia Raffaele, Dalla Valle Raffaele, Boggi Ugo, Geller David, Belli Andrea, Memeo Riccardo, Gruttadauria Salvatore, Mejia Alejandro, Park James O, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Wang Xiaoying, Sutcliffe Robert P, Hasegawa Kiyoshi, Tang Chung-Ngai, Chong Charing C N, Lee Kit-Fai, Meurs Juul, D'Hondt Mathieu, Monden Kazuteru, Lopez-Ben Santiago, Kingham T Peter, Ferrero Alessandro, Ettorre Giuseppe M, Pascual Franco, Cherqui Daniel, Zheng Junhao, Liang Xiao, Soubrane Olivier, Wakabayashi Go, Troisi Roberto I, Cheung Tan-To, Kato Yutaro, Sugioka Atsushi, Dokmak Safi, D'Silva Mizelle, Han Ho-Seong, Nghia Phan Phuoc, Long Tran Cong Duy, Hilal Mohammad Abu, Chen Kuo-Hsin, Fuks David, Aldrighetti Luca, Edwin Bjørn, Goh Brian K P
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany.
Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Ann Surg. 2024 Feb 1;279(2):297-305. doi: 10.1097/SLA.0000000000006027. Epub 2023 Jul 24.
The purpose of this study was to compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.
Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in the existing literature.
This is a post hoc analysis of a multicenter database of 5446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII, and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumor features, and perioperative characteristics were collected and analyzed. Propensity score-matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.
A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%), and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate [10 of 449 (2.2%) vs 54 of 898 (6.0%); P =0.002], less blood loss [100 mL [IQR: 50-200) days vs 150 mL (IQR: 50-350); P <0.001] and a shorter operative time (188 min (IQR: 140-270) vs 222 min (IQR: 158-300); P <0.001]. These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis-lower open conversion rate [1 of 136 (0.7%) vs 17 of 272 (6.2%); P =0.009], less blood loss [100 mL (IQR: 48-200) vs 160 mL (IQR: 50-400); P <0.001], and shorter operative time [190 min (IQR: 141-258) vs 230 min (IQR: 160-312); P =0.003]. Postoperative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.
RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss, and open conversion rate when compared with LLLR.
本研究旨在比较机器人辅助下肝后上段局限性肝切除术（RLLR）与腹腔镜下肝后上段局限性肝切除术（LLLR）的手术效果。
腹腔镜和机器人辅助肝切除术均已用于治疗肝后上段肿瘤。然而，现有文献对这两种手术方式的相对性能和安全性尚未进行充分研究。
这是一项对多中心数据库的事后分析，该数据库包含2008年至2021年间在60个国际中心接受肝后上段（I、IVa、VII和VIII段）RLLR或LLLR的5446例患者。收集并分析了患者的基线人口统计学数据、中心经验和手术量、肿瘤特征以及围手术期特征。进行倾向得分匹配（PSM）分析（1:1和1:2两种比例）以尽量减少选择偏倚。
共有3510例病例符合研究标准，其中3049例接受了LLLR（87%），461例接受了RLLR（13%）。PSM（1:1和1:2）后，RLLR组的开腹手术转换率较低[449例中的10例（2.2%） vs 898例中的54例（6.0%）；P =0.002]，失血量较少[100 mL（四分位间距：50 - 200） vs 150 mL（四分位间距：50 - 350）；P <0.001]，手术时间较短[188分钟（四分位间距：140 - 270） vs 222分钟（四分位间距：158 - 300）；P <0.001]。在肝硬化患者的亚组分析中，同样观察到与RLLR相关的这些围手术期结果改善——开腹手术转换率较低[136例中的1例（0.7%） vs 272例中的17例（6.2%）；P =0.009]，失血量较少[100 mL（四分位间距：48 - 200） vs 160 mL（四分位间距：50 - 400）；P <0.001]，手术时间较短[190分钟（四分位间距：141 - e258） vs 230分钟（四分位间距：160 - 312）；P =0.003]。在总体PSM队列和肝硬化患者亚组中，RLLR和LLLR在再入院、发病率和死亡率方面的术后结果相似。
与LLLR相比，肝后上段的RLLR在手术时间、失血量和开腹手术转换率降低方面具有更好的围手术期结果。
