Abstract
Background
Laparoscopic-assisted (LALR) and hand-assisted (HALR) liver resections have been utilized during the early adoption phase by surgeons when transitioning from open surgery to pure LLR. To date, there are limited data reporting on the outcomes of LALR or HALR compared to LLR. The objective was to compare the perioperative outcomes after LALR and HALR versus pure LLR.
Methods
This is an international multicentric analysis of 6609 patients undergoing minimal-invasive liver resection at 21 centers between 2004 and 2019. Perioperative outcomes were analyzed after propensity score matching (PSM) comparison between LALR and HALR versus LLR.
Results
5279 cases met study criteria of whom 5033 underwent LLR (95.3%), 146 underwent LALR (2.8%) and 100 underwent HALR (1.9%). After 1:4 PSM, LALR was associated with inferior outcomes as evidenced by the longer postoperative stay, higher readmission rate, higher major morbidity rate and higher in-hospital mortality rate. Similarly, 1:6 PSM comparison between HALR and LLR also demonstrated poorer outcomes associated with HALR as demonstrated by the higher open conversion rate and higher blood transfusion rate. All 3 approaches technical variants demonstrated the same oncological radicality (R1 rate).
Conclusion
LALR and HALR performed during the learning curve was associated with inferior perioperative outcomes compared to pure LLR.
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Acknowledgements
Dr. T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant Number P30 CA008747 for this study.
International robotic and laparoscopic liver resection study group investigators Chung-Yip Chan (Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore); Mizelle D’Silva (Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea); Henri Schotte (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium); Celine De Meyere (Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium); Eric C. H. Lai (Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China); Prashant Kadam (Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom); Roberto Montalti (Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy); Qu Liu (Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China); Kit Fai Lee (Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China); Diana Salimgereeva (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia); Ruslan Alikhanov (Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia); Lip Seng Lee (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore); Mikel Prieto (Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain), Jae Young Jang (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea).
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(i) Dr Brian Goh has received travel grants and honorarium from Johnson and Johnson and Transmedic the local distributor for the Da Vinci Robot. (ii) Dr Marco Marino is a consultant for CAVA robotics LLC. (iii) Johann Pratschke reports a research grant from Intuitive Surgical Deutschland GmbH and personal fees or non-financial support from Johnson & Johnson, Medtronic, AFS Medical, Astellas, CHG Meridian, Chiesi, Falk Foundation, La Fource Group, Merck, Neovii, NOGGO, pharma-consult Peterson, and Promedicis. (iv) Moritz Schmelzle reports personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson & Johnson, Takeda, Olympus, Medtronic, Intuitive. (v) Drs Felix Krenzien, Nicholas Syn, Iswanto Sucandy, Adrian Chiow, Mikel Gastaca, Xiaoying Wang, Jae Hoon Lee, Charing Chong, David Fuks, Gi-Hong Choi, Mikhail Efanov, Peter Kingham, Mathieu D’Hondt, Roberto Troisi, Sung-Hoon Choi, Robert Sutcliffe, Rong Liu, Cheung Tan To, Chung Ngai Tang and Ho Seong Han have no conflicts of interest to declare.
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Collaborators of the of the International robotic and laparoscopic liver resection study group investigators are listed in “Acknowledgment”.
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464_2023_10028_MOESM1_ESM.tif
To minimize confounding and selection biases, comparisons were carried out using propensity-score matching predicting the conditional probability of undergoing LALR (versus LLR) exhibited good discrimination (TIF 1804 kb)
464_2023_10028_MOESM2_ESM.tif
To minimize confounding and selection biases, comparisons were carried out using propensity-score matching predicting the conditional probability of undergoing LALR (versus LLR) exhibited good calibration (TIF 1497 kb)
464_2023_10028_MOESM5_ESM.tif
To minimize confounding and selection biases, comparisons were carried out using propensity-score matching predicting the conditional probability of undergoing HALR (versus LLR) displayed good discrimination (TIF 1809 kb)
464_2023_10028_MOESM6_ESM.tif
To minimize confounding and selection biases, comparisons were carried out using propensity-score matching predicting that the conditional probability of undergoing HALR (versus LLR) displayed good calibration (TIF 1555 kb)
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Krenzien, F., Schmelzle, M., Pratschke, J. et al. Propensity score-matched analysis of laparoscopic-assisted and hand-assisted laparoscopic liver resection versus pure laparoscopic liver resection: an international multicenter study. Surg Endosc 37, 5482–5493 (2023). https://doi.org/10.1007/s00464-023-10028-7
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DOI: https://doi.org/10.1007/s00464-023-10028-7