Pilz da Cunha Gabriela, Hoogteijling Tijs J, Besselink Marc G, Alzoubi Mohammad N, Swijnenburg Rutger-Jan, Abu Hilal Mohammad
Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Amsterdam, The Netherlands.
Int J Surg. 2025 Aug 1;111(8):5549-5571. doi: 10.1097/JS9.0000000000002567. Epub 2025 Jun 5.
The technical advantages of robotic platforms may facilitate minimally invasive liver resections, improving outcomes over the laparoscopic approach. This meta-analysis aimed to compare outcomes of robotic liver resection (RLR) versus laparoscopic liver resection (LLR).
A systematic literature search identified matched cohort studies and randomized controlled trials comparing RLR and LLR from 2003 to 2024. Studies concerning transplant hepatectomy and retrospective studies with fewer than 50 patients per group were excluded. Perioperative outcomes were analyzed in a meta-analysis, with subgroup analyses for minor anterolateral (AL), minor posterosuperior (PS), and major resections.
Overall, 31 studies with 8989 patients undergoing RLR and 43 474 LLR were included, with 8207 RLRs and 9763 LLRs after matching. RLR was associated with lower conversion (RR 0.41 [95% CI, 0.32-0.52]), overall morbidity (RR 0.92 [95% CI, 0.84-1.00]), and severe morbidity rate (RR 0.81 [95% CI, 0.70-0.94]), as well as higher rates of R0 resection (RR 1.02 [95% CI, 1.01-1.03]) and readmission (RR 1.24 [95% CI, 1.09-1.41]). There were no significant differences in blood loss, transfusion, Pringle use, operative time, hospital stay, and mortality. RLR reduced blood loss in minor AL and PS resections, with fewer transfusions also observed in minor AL. RLR was associated with shorter hospital stays in minor PS resections. Notably, RLR was associated with less overall morbidity in minor AL and less severe morbidity in major resections. Available results on long-term oncological outcomes were not suitable for meta-analysis.
RLR demonstrates advantages in several key perioperative outcomes compared to LLR across the full spectrum of liver resection complexity.
机器人平台的技术优势可能有助于微创肝切除术，与腹腔镜手术相比可改善手术效果。本荟萃分析旨在比较机器人肝切除术（RLR）与腹腔镜肝切除术（LLR）的手术效果。
通过系统的文献检索，确定了2003年至2024年期间比较RLR和LLR的匹配队列研究和随机对照试验。排除了有关移植肝切除术的研究以及每组患者少于50例的回顾性研究。在荟萃分析中对围手术期结果进行分析，并对小前外侧（AL）、小后上侧（PS）和大肝切除术进行亚组分析。
总体而言，纳入了31项研究，其中8989例患者接受RLR，43474例患者接受LLR，匹配后分别有8207例RLR和9763例LLR。RLR与较低的中转率（RR 0.41 [95% CI，0.32 - 0.52]）、总体发病率（RR 0.92 [95% CI，0.84 - 1.00]）和严重发病率（RR 0.81 [95% CI，0.70 - 0.94]）相关，同时R0切除率（RR 1.02 [95% CI，1.01 - 1.03]）和再入院率（RR 1.24 [95% CI，1.09 - 1.41]）更高。在失血量、输血、使用Pringle法、手术时间、住院时间和死亡率方面无显著差异。RLR减少了小AL和PS肝切除术中的失血量，小AL肝切除术中输血也较少。RLR与小PS肝切除术中较短的住院时间相关。值得注意的是，RLR与小AL肝切除术中较低的总体发病率以及大肝切除术中较低的严重发病率相关。关于长期肿瘤学结果的现有结果不适合进行荟萃分析。
在整个肝切除复杂性范围内，与LLR相比，RLR在几个关键围手术期结果方面显示出优势。
