Giannone Fabio, Cassese Gianluca, Del Basso Celeste, Alagia Mariantonietta, Palucci Marco, Sangiuolo Federico, Panaro Fabrizio
Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Surg Endosc. 2025 Jan;39(1):64-76. doi: 10.1007/s00464-024-11428-z. Epub 2024 Dec 2.
The outcomes of minimally invasive liver surgery for posterosuperior segments (PS) are still debated. Since the results of ongoing trials focusing on the results of laparoscopic liver resection (LLR) and robotic liver resection (RLR) in this setting are still awaited, the best evidence currently comes from retrospective propensity-score matched (PSM) studies. The aim of this meta-analysis was to assess the outcomes of RLR for difficult located lesions and to provide evidence for its use in clinical practice.
A systematic review with meta-analysis was conducted to evaluate the safety and efficacy of LLR and RLR for PS segments. The Medline, Embase and Web of Science Library electronic databases were searched to identify available research published up to June 2024.
Five studies with a total of 2907 patients (RLR: n = 1084; LLR: n = 1823) were included in the meta-analysis. The RLR group had less estimated blood loss (EBL) (MD: - 88.3, 95% CI - 144.2-- 32.3; p = 0.012), fewer blood transfusions (OR 0.70, 95% CI 0.39-0.80, p = 0.033), and a shorter operative time (MD - 27.3, 95% CI - 49.4-- 5.1; p = 0.027). No differences in postoperative morbidity, mortality and R1 resection rates were observed.
RLR for lesions in the PS segments are safe and effective, and may have superior surgical outcomes than LLR.
后上肝段（PS）的微创肝脏手术效果仍存在争议。由于聚焦于此情况下腹腔镜肝切除术（LLR）和机器人辅助肝切除术（RLR）结果的正在进行的试验结果仍未可知，目前最佳证据来自回顾性倾向评分匹配（PSM）研究。本荟萃分析的目的是评估RLR治疗位置困难病变的效果，并为其在临床实践中的应用提供证据。
进行了一项系统评价和荟萃分析，以评估LLR和RLR治疗PS段的安全性和有效性。检索了Medline、Embase和科学网图书馆电子数据库，以识别截至2024年6月发表的可用研究。
五项研究共纳入2907例患者（RLR：n = 1084；LLR：n = 1823）进行荟萃分析。RLR组估计失血量（EBL）较少（MD：- 88.3，95%CI - 144.2-- 32.3；p = 0.012），输血次数较少（OR 0.70，95%CI 0.39 - 0.80，p = 0.033），手术时间较短（MD - 27.3，95%CI - 49.4-- 5.1；p = 0.027）。术后发病率、死亡率和R1切除率未见差异。
RLR治疗PS段病变安全有效，手术效果可能优于LLR。
