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Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score matched study of 10.075 patients

Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score matched study of 10.075 patients
Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score matched study of 10.075 patients

Objective: To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. Background: Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. Methods: In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. Results: Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. Conclusions: While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.

Aged, Female, Hepatectomy/methods, Humans, Laparoscopy/methods, Liver Diseases/surgery, Male, Middle Aged, Postoperative Complications/epidemiology, Propensity Score, Retrospective Studies, Robotic Surgical Procedures, Treatment Outcome, liver neoplasms, treatment outcome, hepatectomy, laparoscopic liver resection, robotic liver resection
0003-4932
108-117
Sijberden, Jasper P.
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Hoogteijling, Tijs J.
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Aghayan, Davit
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Ratti, Francesca
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Tan, Ek-Khoon
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Morrison-Jones, Victoria
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Lanari, Jacopo
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Haentjens, Louis
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Wei, Kongyuan
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Tzedakis, Stylianos
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Martinie, John
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Caula, Cèlia
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Geller, David
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Rehman, Shafiq
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Jovine, Elio
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Efanov, Mikhail
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Dagher, Ibrahim
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Giuliante, Felice
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Sparrelid, Ernesto
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Ahmad, Jawad
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Gallagher, Tom
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Schmelzle, Moritz
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Swijnenburg, Rutger-Jan
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Fretland, Åsmund Avdem
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Cipriani, Federica
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Koh, Ye-Xin
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White, Steven
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Rotellar, Fernando
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Serrano, Pablo E
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Vivarelli, Marco
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Ruzzenente, Andrea
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Ferrero, Alessandro
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Di Benedetto, Fabrizio
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Primrose, John N.
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Abu Hilal, Mohammad
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et al.
for the International consortium on Minimally Invasive Liver Surgery (I-LMS)
Sijberden, Jasper P.
9d954519-5768-4cc9-a6c4-2cb3a051a212
Hoogteijling, Tijs J.
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Aghayan, Davit
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Ratti, Francesca
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Tan, Ek-Khoon
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Morrison-Jones, Victoria
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Lanari, Jacopo
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Haentjens, Louis
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Wei, Kongyuan
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Tzedakis, Stylianos
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Martinie, John
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Osei Bordom, Daniel
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Zimmitti, Giuseppe
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Crespo, Kaitlyn
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Magistri, Paolo
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Russolillo, Nadia
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Conci, Simone
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Görgec, Burak
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Benedetti Cacciaguerra, Andrea
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D'Souza, Daniel
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Zozaya, Gabriel
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Caula, Cèlia
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Geller, David
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Robles Campos, Ricardo
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Croner, Roland
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Rehman, Shafiq
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Jovine, Elio
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Efanov, Mikhail
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Alseidi, Adnan
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Dagher, Ibrahim
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Giuliante, Felice
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Sparrelid, Ernesto
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Ahmad, Jawad
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Gallagher, Tom
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Schmelzle, Moritz
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Swijnenburg, Rutger-Jan
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Fretland, Åsmund Avdem
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Cipriani, Federica
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Koh, Ye-Xin
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White, Steven
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Lopez Ben, Santi
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Rotellar, Fernando
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Vivarelli, Marco
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Ferrero, Alessandro
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Di Benedetto, Fabrizio
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Primrose, John N.
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Abu Hilal, Mohammad
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Sijberden, Jasper P., Hoogteijling, Tijs J. and Aghayan, Davit , et al. and for the International consortium on Minimally Invasive Liver Surgery (I-LMS) (2024) Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score matched study of 10.075 patients. Annals of Surgery, 280 (1), 108-117. (doi:10.1097/SLA.0000000000006267).

Record type: Article

Abstract

Objective: To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. Background: Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. Methods: In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. Results: Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. Conclusions: While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.

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robotic_versus_laparoscopic_liver_resection_in.807 - Accepted Manuscript
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e-pub ahead of print date: 14 March 2024
Published date: 1 July 2024
Additional Information: Publisher Copyright: © 2024 Wolters Kluwer Health. All rights reserved.
Keywords: Aged, Female, Hepatectomy/methods, Humans, Laparoscopy/methods, Liver Diseases/surgery, Male, Middle Aged, Postoperative Complications/epidemiology, Propensity Score, Retrospective Studies, Robotic Surgical Procedures, Treatment Outcome, liver neoplasms, treatment outcome, hepatectomy, laparoscopic liver resection, robotic liver resection

Identifiers

Local EPrints ID: 488248
URI: http://eprints.soton.ac.uk/id/eprint/488248
ISSN: 0003-4932
PURE UUID: 0e6f5e45-b527-451f-9832-97f53086b8de
ORCID for John N. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 19 Mar 2024 17:38
Last modified: 12 Jul 2024 01:35

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Contributors

Author: Jasper P. Sijberden
Author: Tijs J. Hoogteijling
Author: Davit Aghayan
Author: Francesca Ratti
Author: Ek-Khoon Tan
Author: Victoria Morrison-Jones
Author: Jacopo Lanari
Author: Louis Haentjens
Author: Kongyuan Wei
Author: Stylianos Tzedakis
Author: John Martinie
Author: Daniel Osei Bordom
Author: Giuseppe Zimmitti
Author: Kaitlyn Crespo
Author: Paolo Magistri
Author: Nadia Russolillo
Author: Simone Conci
Author: Burak Görgec
Author: Andrea Benedetti Cacciaguerra
Author: Daniel D'Souza
Author: Gabriel Zozaya
Author: Cèlia Caula
Author: David Geller
Author: Ricardo Robles Campos
Author: Roland Croner
Author: Shafiq Rehman
Author: Elio Jovine
Author: Mikhail Efanov
Author: Adnan Alseidi
Author: Riccardo Memeo
Author: Ibrahim Dagher
Author: Felice Giuliante
Author: Ernesto Sparrelid
Author: Jawad Ahmad
Author: Tom Gallagher
Author: Moritz Schmelzle
Author: Rutger-Jan Swijnenburg
Author: Åsmund Avdem Fretland
Author: Federica Cipriani
Author: Ye-Xin Koh
Author: Steven White
Author: Santi Lopez Ben
Author: Fernando Rotellar
Author: Pablo E Serrano
Author: Marco Vivarelli
Author: Andrea Ruzzenente
Author: Alessandro Ferrero
Author: Fabrizio Di Benedetto
Author: Mohammad Abu Hilal
Corporate Author: et al.
Corporate Author: for the International consortium on Minimally Invasive Liver Surgery (I-LMS)

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