General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
HPB (Oxford). 2024 Aug;26(8):1062-1071. doi: 10.1016/j.hpb.2024.05.013. Epub 2024 May 23.
Postoperative complications are vital factors affecting the prognosis of patients with hepatocellular carcinoma (HCC), especially for complex hepatectomy. The present study aimed to compare perioperative complications between laparoscopic and robotic complex hepatectomy (LCH vs. RCH).
Patients with solitary HCC after complex hepatectomy were collected from a multicenter database. Propensity score-matched (PSM) analysis was adopted to control confounding bias. Multivariable analysis was performed to determine the prognostic factors.
436 patients were included. After PSM, 43 patients were included in both the LCH and RCH groups. The results showed that compared to LCH, RCH had lower rates of blood loss and transfusion, and lower postoperative 30-day and major morbidity, and post-hepatectomy liver failure (PHLF) (all P < 0.05). Additionally, the length of hospital stay was shorter in the RCH group (P = 0.026). Multivariable analysis showed RCH is an independent protective factor for reducing the 30-day morbidity, major morbidity and PHLF.
RCH has advantages over LCH in the minimally invasive treatment of complex HCC, as it can reduce the incidence of postoperative morbidity. Therefore, RCH should be considered for patients with HCC who require complex hepatectomy.
术后并发症是影响肝细胞癌（HCC）患者预后的重要因素，尤其是对于复杂肝切除术。本研究旨在比较腹腔镜和机器人辅助复杂肝切除术（LCH 与 RCH）的围手术期并发症。
从多中心数据库中收集了接受复杂肝切除术后单发 HCC 的患者。采用倾向评分匹配（PSM）分析来控制混杂偏倚。进行多变量分析以确定预后因素。
共纳入 436 例患者。经过 PSM 后，LCH 和 RCH 组各有 43 例患者纳入。结果显示，与 LCH 相比，RCH 的出血量和输血率较低，术后 30 天和主要发病率以及术后肝衰竭（PHLF）较低（均 P < 0.05）。此外，RCH 组的住院时间较短（P = 0.026）。多变量分析显示，RCH 是降低 30 天发病率、主要发病率和 PHLF 的独立保护因素。
RCH 在治疗复杂 HCC 的微创方面优于 LCH，因为它可以降低术后发病率。因此，对于需要复杂肝切除术的 HCC 患者，应考虑使用 RCH。
