Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments
Authors: Krenzien Felix , Schmelzle Moritz , Pratschke Johann , Feldbrügge Linda , Liu Rong , Liu Qu , Zhang Wanguang , Zhao Joseph J. , Tan Hwee-Leong , Cipriani Federica , Hoogteijling Tijs J. , Aghayan Davit L. , Fretland Åsmund Avdem , 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 , Gastaca Mikel , Vivarelli Marco , Giuliante Felice , Valle Bernardo Dalla , Ruzzenente Andrea , Yong Chee-Chien , Chen Zewei , Yin Mengqiu , Fondevila Constantino , Efanov Mikhail , Morise Zenichi , Di Benedetto Fabrizio , Brustia Raffaele , Valle Raffaele Dalla , 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. , Hasegawa Kiyoshi , Tang Chung-Ngai , Chong Charing C. N. , Lee Kit-Fai , Meurs Juul , D’Hondt Mathieu , Monden Kazuteru , Lopez-Ben Santiago , Kingham T. Peter , Ferrero Alessandro , Ettorre Giuseppe Maria , Pascual Franco , Cherqui Daniel , Zheng Junhao , Liang Xiao , Soubrane Olivier , Wakabayashi Go , Troisi Roberto I. , Cheung Tan-To , Kato Yutaro , Sugioka Atsushi , Dokmak Safi , D’Silva Mizelle , Han Ho-Seong , Nghia Phan Phuoc , Long Tran Cong duy , Hilal Mohammad Abu , Chen Kuo-Hsin , Fuks David , Aldrighetti Luca , Edwin Bjørn , Goh Brian K. P. ,   International robotic and laparoscopic liver resection study group investigators
Published: July 2023

Objective:
To compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.

Background:
Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in existing literature.

Methods:
This is a post hoc analysis of a multicenter database of 5,446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumour features and perioperative characteristics were collected and analysed. Propensity score matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.

Results:
A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%) and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate (10 of 449 [2.2%] vs. 54 of 898 [6.0%]; P=0.002), less blood loss (100 mL [IQR; 50-200] days vs. 150 mL [IQR; 50-350]; P<0.001) and a shorter operative time (188 min [IQR; 140-270] vs. 222 min [IQR; 158-300]; P<0.001). These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis - lower open conversion rate (1 of 136 [0.7%] vs. 17 of 272 [6.2%]; P=0.009), less blood loss (100 mL [IQR; 48-200] vs. 160 mL [IQR; 50-400]; P<0.001) and shorter operative time (190 min [IQR; 141-258] vs. 230 min [IQR; 160-312]; P=0.003). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.

Conclusion:
RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss and open conversion rate when compared to LLLR.