Hu Jie, Guo Yuxin, Wang Xiaoying, Yeow Marcus, Wu Andrew G R, Fuks David, Soubrane Olivier, Dokmak Safi, Gruttadauria Salvatore, Zimmitti Giuseppe, Ratti Francesca, Kato Yutaro, Scatton Olivier, Herman Paulo, Aghayan Davit L, Marino Marco V, Croner Roland S, Mazzaferro Vincenzo, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Choi Sung Hoon, Lee Jae Hoon, Gastaca Mikel, Vivarelli Marco, Giuliante Felice, Ruzzenente Andrea, Yong Chee-Chien, Yin Mengqiu, Fondevila Constantino, Efanov Mikhail, Morise Zenichi, Di Benedetto Fabrizio, Brustia Raffaele, Valle Raffaele Dalla, Boggi Ugo, Geller David, Belli Andrea, Memeo Riccardo, Mejia Alejandro, Park James O, Rotellar Fernando, Choi Gi-Hong, Robles-Campos Ricardo, Hasegawa Kiyoshi, Swijnenburg Rutger-Jan, Sutcliffe Robert P, Pratschke Johann, Lai Eric C H, Chong Charing C N, D'Hondt Mathieu, Monden Kazuteru, Lopez-Ben Santiago, Kingham T Peter, Schmelzle Moritz, Hawksworth Jason, Peng Yufu, Ferrero Alessandro, Ettorre Giuseppe Maria, Cherqui Daniel, Liang Xiao, Wakabayashi Go, Troisi Roberto I, Cillo Umberto, Cheung Tan-To, Sugimoto Motokazu, Sugioka Atsushi, Han Ho-Seong, Long Tran Cong Duy, Hilal Mohammad Abu, Zhang Wanguang, Wei Yonggang, Chen Kuo-Hsin, Aldrighetti Luca, Edwin Bjorn, Liu Rong, Goh Brian K P
Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore.
Ann Surg. 2024 Sep 5. doi: 10.1097/SLA.0000000000006523.
To compare the outcomes of robotic minor liver resections (RMLR) versus laparoscopic (L) MLR of the anterolateral segments.
Robotic liver surgery has been gaining prominence over the years with increasing usage for a myriad of hepatic resections. Robotic liver resections(RLR) has demonstrated non-inferiority to laparoscopic(L)LR while illustrating advantages over conventional laparoscopy especially for technically difficult and major LR. However, the advantage of RMLR for the anterolateral(AL) (segments II, III, IVb, V and VI) segments, has not been clearly demonstrated.
Between 2008 to 2022, 15,356 of 29,861 patients from 68 international centres underwent robotic(R) or laparoscopic minor liver resections (LMLR) for the AL segments Propensity score matching (PSM) analysis was performed for matched analysis.
10,517 patients met the study criteria of which 1,481 underwent RMLR and 9,036 underwent LMLR. A PSM cohort of 1,401 patients in each group were identified for analysis. Compared to the LMLR cohort, the RMLR cohort demonstrated significantly lower median blood loss (75ml vs. 100ml, P<0.001), decreased blood transfusion (3.1% vs. 5.4%, P=0.003), lower incidence of major morbidity (2.5% vs. 4.6%, P=0.004), lower proportion of open conversion (1.2% vs. 4.5%, P<0.001), shorter post operative stay (4 days vs. 5 days, P<0.001), but higher rate of 30-day readmission (3.5% vs. 2.1%, P=0.042). These results were then validated by a 1:2 PSM analysis. In the subset analysis for 3,614 patients with cirrhosis, RMLR showed lower median blood loss, decreased blood transfusion, lower open conversion and shorter post operative stay than LMLR.
RMLR demonstrated statistically significant advantages over LMLR even for resections in the AL segments although most of the observed clinical differences were minimal.
比较机器人辅助下小范围肝切除术（RMLR）与腹腔镜下（L）前外侧段小范围肝切除术的疗效。
近年来，随着机器人肝脏手术在众多肝脏切除术中的应用不断增加，其地位日益突出。机器人肝脏切除术（RLR）已被证明不劣于腹腔镜（L）肝脏切除术，同时显示出相对于传统腹腔镜手术的优势，特别是在技术难度较大的大型肝脏切除术中。然而，RMLR在前外侧（AL）段（II、III、IVb、V和VI段）的优势尚未得到明确证实。
2008年至2022年期间，来自68个国际中心的29861例患者中有15356例接受了机器人辅助（R）或腹腔镜下小范围肝切除术（LMLR）治疗AL段。采用倾向评分匹配（PSM）分析进行匹配分析。
10517例患者符合研究标准，其中1481例接受了RMLR，9036例接受了LMLR。每组确定了1401例患者的PSM队列进行分析。与LMLR队列相比，RMLR队列的术中中位失血量显著更低（75ml对100ml，P<0.001），输血率降低（3.1%对5.4%），严重并发症发生率更低（2.5%对4.6%，P=0.004），中转开腹比例更低（1.2%对4.5%，P<0.001），术后住院时间更短（4天对5天，P<0.001），但30天再入院率更高（3.5%对2.1%，P=0.042）。这些结果随后通过1:2的PSM分析得到验证。在对3614例肝硬化患者的亚组分析中，RMLR显示出比LMLR更低的术中中位失血量、更低的输血率、更低的中转开腹率和更短的术后住院时间。
即使是在AL段的肝切除术中，RMLR也显示出相对于LMLR在统计学上的显著优势，尽管观察到的大多数临床差异很小。
