Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies
Authors: Liu Qu , Zhang Wanguang , Zhao Joseph J. , Syn Nicholas L. , Cipriani Federica , Alzoubi Mohammad , Aghayan Davit L. , Siow Tiing-Foong , Lim Chetana , Scatton Olivier , Herman Paulo , Coelho Fabricio Ferreira , Marino Marco V. , Mazzaferro Vincenzo , Chiow Adrian K. H. , Sucandy Iswanto , Ivanecz Arpad , Choi Sung-Hoon , Lee Jae Hoon , Prieto Mikel , Vivarelli Marco , Giuliante Felice , Dalla Valle Bernardo , Ruzzenente Andrea , Yong Chee-Chien , Chen Zewei , Yin Mengqiu , Fondevila Constantino , Efanov Mikhail , Morise Zenichi , Di Benedetto Fabrizio , Brustia Raffaele , Dalla Valle Raffaele , Boggi Ugo , Geller David , Belli Andrea , Memeo Riccardo , Gruttadauria Salvatore , Mejia Alejandro , Park James O. , Rotellar Fernando , Choi Gi-Hong , Robles-Campos Ricardo , Wang Xiaoying , Sutcliffe Robert P. , Schmelzle Moritz , Pratschke Johann , Tang Chung-Ngai , Chong Charing C. N. , Lee Kit-Fai , Meurs Juul , D’Hondt Mathieu , Monden Kazuteru , Lopez-Ben Santiago , Kingham Thomas Peter , Ferrero Alessandro , Ettorre Giuseppe Maria , Levi Sandri Giovanni Battista , Saleh Mansour , Cherqui Daniel , Zheng Junhao , Liang Xiao , Mazzotta Alessandro , Soubrane Olivier , Wakabayashi Go , Troisi Roberto I. , Cheung Tan-To , Kato Yutaro , Sugioka Atsushi , D’Silva Mizelle , Han Ho-Seong , Nghia Phan Phuoc , Long Tran Cong duy , Edwin Bjørn , Fuks David , Chen Kuo-Hsin , Abu Hilal Mohammad , Aldrighetti Luca , Liu Rong , Goh Brian K. P. ,   International robotic and laparoscopic liver resection study group investigators
Published: April 2023

Objective:
To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH).

Background:
Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH.

Methods:
This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups

Results:
A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047].

Conclusions:
This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.