Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena "Policlinico", University of Modena and Reggio Emilia, 41124, Modena, Italy.
Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Surg Endosc. 2024 Jun;38(6):3448-3454. doi: 10.1007/s00464-024-10804-z. Epub 2024 May 2.
In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS.
The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications.
Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56).
Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.
在主要不可切除的肝脏肿瘤中，联合肝脏离断和门静脉结扎的分阶段肝切除术（ALPPS）可能通过快速广泛的肝再生实现治愈性的两阶段肝切除术。然而，人们对该手术的侵袭性提出了担忧。全机器人 ALPPS 有可能通过减少创伤来降低术后发病率。本研究旨在比较开放和全机器人 ALPPS 的围手术期结果。
该双中心研究纳入了 2015 年 1 月至 2022 年 7 月期间来自瑞士苏黎世大学医院的开放 ALPPS 病例和来自意大利摩德纳和雷焦艾米利亚大学的全机器人 ALPPS 病例。主要结果是术中参数和总体并发症。
开放和全机器人 ALPPS 分别进行了 36 例和 7 例。与开放 ALPPS 相比，全机器人 ALPPS 在两个阶段后出血量均较少（分别为 418±237ml 与 319±197ml；P=0.04 和 631±354ml 与 258±53ml；P=0.01），且术中中转率较高（分别为 86%与 37%；P=0.02）。全机器人 ALPPS 后两个阶段的手术时间均较长（分别为 371±70min 与 449±81min；P=0.01 和 282±87min 与 373±90min；P=0.02）。ALPPS 第二阶段后，总体并发症发生率（86%与 86%；P=1.00）和主要并发症发生率（43%与 39%；P=0.86）无差异。总住院时间相似（分别为 23±17 天与 26±13 天；P=0.56）。
在有经验的机器人中心，全机器人 ALPPS 安全实施，与开放 ALPPS 相比，具有改善围手术期结果的潜力。机器人方法可能使 ALPPS 的围手术期风险特征更接近门静脉栓塞/肝静脉阻断的介入技术。
