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Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Controversies exist among liver surgeons regarding clinical outcomes of the laparoscopic versus the robotic approach for major complex hepatectomies. The authors therefore designed a study to examine and compare the perioperative outcomes of laparoscopic left hepatectomy or extended left hepatectomy (L-LH/L-ELH) versus robotic left hepatectomy or extended left hepatectomy (R-LH/R-ELH) using a large international multicenter collaborative database.

Methods

An international multicenter retrospective analysis of 580 patients undergoing L-LH/L-ELH or R-LH/R-ELH at 25 specialized hepatobiliary centers worldwide was undertaken. Propensity score-matching (PSM) was used at a 1:1 nearest-neighbor ratio according to 15 perioperative variables, including demographics, tumor characteristics, Child-Pugh score, presence of portal hypertension, multiple resections, histologic diagnosis, and Iwate difficulty grade.

Results

Before the PSM, 190 (32 %) patients underwent R-LH/R-ELH, and 390 (68 %) patients underwent L-LH/L-ELH. After the matching, 164 patients were identified in each arm without significant differences in demographics, preoperative variables, medical history, tumor pathology, tumor characteristics, or Iwate score. Regarding intra- and postoperative outcomes, the rebotic approach had significantly less estimated blood loss (EBL) (100 ml [IQR 200 ml] vs 200 ml [IQR 235 ml]; p = 0.029), fewer conversions to open operations (n = 4 [2.4 %] vs n = 13, [7.9 %]; p = 0.043), and a shorter hospital stay (6 days [IQR 3 days] vs 7 days [IQR 3.3 days]; p = 0.009).

Conclusion

Both techniques are safe and feasible in major hepatic resections. Compared with L-LH/L-ELH, R-LH/R-ELH is associated with less EBL, fewer conversions to open operations, and a shorter hospital stay.

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Acknowledgement

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, 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); Felix Krenzien (Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany); Moritz Schmelzle (Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany); Prashant Kadam (Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK); 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, New Territories, 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 Gastaca (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); Chetana Lim (Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, APHP, Sorbonne Université, Paris, France); Kevin P. Labadie (Department of Surgery, University of Washington Medical Center. Seattle, WA, USA)

Funding

Dr. Kingham was partially supported by the US National Cancer Center Institute MSKCC Core Grant Number P30 CA008747 for this study.

Author information

Author notes

  1. Iswanto Sucandy and Shlomi Rayman contributed equally to this article.

Authors and Affiliations

  1. AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA

    Iswanto Sucandy MD, FACS & Shlomi Rayman MD

  2. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China

    Eric C. Lai MBChB, FRACS & Chung-Ngai Tang MBBS, FRCS

  3. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and Ministry of Health Holdings Singapore, Singapore, Singapore

    Yvette Chong MBBS

  4. Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia

    Mikhail Efanov MD, PhD

  5. Department of Digestive, Oncologic, and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France

    David Fuks MD, PhD

  6. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Gi-Hong Choi MD

  7. Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, SAR, China

    Charing C. Chong MBChB, MSc, FRCS

  8. Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore, Singapore

    Adrian K. H. Chiow MBBS, MMed, FRCS

  9. General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy

    Marco V. Marino MD, PhD, FACS, FEBS

  10. Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy

    Marco V. Marino MD, PhD, FACS, FEBS

  11. Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain

    Mikel Prieto MD

  12. Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jae-Hoon Lee MD, PhD

  13. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    T. Peter Kingham MD

  14. Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium

    Mathieu D’Hondt MD, PhD

  15. Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy

    Roberto I. Troisi MSc, MD, PhD, FEBS

  16. Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

    Sung Hoon Choi MD

  17. Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom

    Robert P. Sutcliffe MD, FRCS

  18. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China

    Tan-To Cheung MBBS, FRCS

  19. HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain

    Fernando Rotellar MD, PhD

  20. Institute of Health Research of Navarra (IdisNA), Pamplona, Spain

    Fernando Rotellar MD, PhD

  21. Department of Surgery, University of Washington Medical Center and Fred Hutchinson Cancer Center, Seattle, WA, USA

    James O. Park MD

  22. Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France

    Olivier Scatton MD, PhD

  23. Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea

    Ho-Seong Han MD, PhD

  24. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany

    Johann Pratschke MD

  25. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China

    Xiaoying Wang MD

  26. Faculty of Hepatopancreatobiliary Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China

    Rong Liu MD, PhD

  27. Department of Hepatopancreatobiliary and Transplant Surgery, Division of Surgery, Singapore General Hospital and Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore

    Brian K. P. Goh MBBS, MSc, MMed, FRCS

  28. Duke-National University of Singapore Medical School, Singapore, Singapore

    Brian K. P. Goh MBBS, MSc, MMed, FRCS

Authors
  1. Iswanto Sucandy MD, FACS
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  2. Shlomi Rayman MD
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  6. Mikhail Efanov MD, PhD
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  13. Jae-Hoon Lee MD, PhD
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  14. T. Peter Kingham MD
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  15. Mathieu D’Hondt MD, PhD
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  16. Roberto I. Troisi MSc, MD, PhD, FEBS
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  27. Brian K. P. Goh MBBS, MSc, MMed, FRCS
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Consortia

International Robotic, Laparoscopic Liver Resection Study Group Investigators

  • Chung-Yip Chan
  • , Mizelle D’Silva
  • , Henri Schotte
  • , Celine De Meyere
  • , Felix Krenzien
  • , Moritz Schmelzle
  • , Prashant Kadam
  • , Roberto Montalti
  • , Qu Liu
  • , Kit-Fai Lee
  • , Diana Salimgereeva
  • , Ruslan Alikhanov
  • , Lip Seng Lee
  • , Mikel Gastaca
  • , Jae Young Jang
  • , Chetana Lim
  •  & Kevin P. Labadie

Corresponding author

Correspondence to Brian K. P. Goh MBBS, MSc, MMed, FRCS.

Ethics declarations

Disclosure

Dr Brian K. P. Goh has received travel grants and honorarium from Johnson and Johnson and Transmedic, the local distributor for the Da Vinci robot. Dr Marco V. Marino is a consultant for CAVA robotics LLC. 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. Moritz Schmelzle reports personal fees or other support outside of the submitted work from Merck, Bayer, ERBE, Amgen, Johnson & Johnson, Takeda, Olympus, Medtronic, Intuitive. Fernando Rotellar reports speaker fees and support outside the submitted work from Integra, Medtronic, Olympus, Corza, Sirtex and Johnson & Johnson. The remaining authors haved no conflicts of interest.

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Sucandy, I., Rayman, S., Lai, E.C. et al. Robotic Versus Laparoscopic Left and Extended Left Hepatectomy: An International Multicenter Study Propensity Score-Matched Analysis. Ann Surg Oncol 29, 8398–8406 (2022). https://doi.org/10.1245/s10434-022-12216-6

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