Propensity Score–Matched Analysis Comparing Robotic and Laparoscopic Right and Extended Right Hepatectomy
Authors: Charing C. Chong, David Fuks, Kit-Fai Lee, Joseph J. Zhao, Gi Hong Choi, Iswanto Sucandy, Adrian K. H. Chiow, Marco V. Marino, Mikel Gastaca, Xiaoying Wang, Jae Hoon Lee, Mikhail Efanov, T. Peter Kingham, Mathieu D’Hondt, Roberto I. Troisi, Sung-Hoon Choi, Robert P. Sutcliffe, Chung-Yip Chan, Eric C. H. Lai, James O. Park, Fabrizio Di Benedetto, Fernando Rotellar, Atsushi Sugioka, Fabricio Ferreira Coelho, Alessandro Ferrero, Tran Cong Duy Long, Chetana Lim, Olivier Scatton, Qu Liu, Moritz Schmelzle, Johann Pratschke, Tan-To Cheung, Rong Liu, Ho-Seong Han, Chung Ngai Tang, Brian K. P. Goh, Mizelle D’Silva, Henri Schotte, Celine De Meyere, Felix Krenzien, Prashant Kadam, Roberto Montalti, Mariano Giglio, Diana Salimgereeva, Ruslan Alikhanov, Lip Seng Lee, Mikel Prieto, Jae Young Jang, Paulo Magistri, Kevin P. Labadie, Phan Phuoc Nghia, Masayuki Kojima, Yutaro Kato, Paulo Herman, Jaime A. P. Kruger, Nicholas Syn
Journal: JAMA Surgery (2022)

Laparoscopic and robotic techniques have both been well adopted as safe options in selected patients undergoing hepatectomy. However, it is unknown whether either approach is superior, especially for major hepatectomy such as right hepatectomy or extended right hepatectomy (RH/ERH).To compare the outcomes of robotic vs laparoscopic RH/ERH.In this case-control study, propensity score matching analysis was performed to minimize selection bias. Patients undergoing robotic or laparoscopic RH/EHR at 29 international centers from 2008 to 2020 were included.Robotic vs laparoscopic RH/ERH.Data on patient demographics, tumor characteristics, and short-term perioperative outcomes were collected and analyzed.Of 989 individuals who met study criteria, 220 underwent robotic and 769 underwent laparoscopic surgery. The median (IQR) age in the robotic RH/ERH group was 61.00 (51.86-69.00) years and in the laparoscopic RH/ERH group was 62.00 (52.03-70.00) years. Propensity score matching resulted in 220 matched pairs for further analysis. Patients' demographics and tumor characteristics were comparable in the matched cohorts. Robotic RH/ERH was associated with a lower open conversion rate (19 of 220 [8.6%] vs 39 of 220 [17.1%]; P = .01) and a shorter postoperative hospital stay (median [IQR], 7.0 [5.0-10.0] days; mean [SD], 9.11 [7.52] days vs median [IQR], 7.0 [5.75-10.0] days; mean [SD], 9.94 [8.99] days; P = .048). On subset analysis of cases performed between 2015 and 2020 after a center's learning curve (50 cases), robotic RH/ERH was associated with a shorter postoperative hospital stay (median [IQR], 6.0 [5.0-9.0] days vs 7.0 [6.0-9.75] days; P = .04) with a similar conversion rate (12 of 220 [7.6%] vs 17 of 220 [10.8%]; P = .46).Robotic RH/ERH was associated with a lower open conversion rate and shorter postoperative hospital stay compared with laparoscopic RH/ERH. The difference in open conversion rate was associated with a significant decrease for laparoscopic but not robotic RH/ERH after a center had mounted the learning curve. Use of robotic platform may help to overcome the initial challenges of minimally invasive RH/ERH.