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Robotic versus laparoscopic left and extended left hepatectomy: an international multicenter study propensity score-matched analysis

Autores: Sucandy, I.; Rayman, S.; Lai, E. C.; Tang, C. N.; Chong, Y.; Efanov, M.; Fuks, D.; Choi, G. H.; Chong, C. C.; Chiow, A. K. H.; Marino, M. V.; Prieto, M.; Lee, J. H.; Kingham, T. P.; D'Hondt, M.; Troisi, R. I.; Choi, S. H.; Sutcliffe, R. P.; Cheung, T. T.; Rotellar Sastre, Fernando; Park, J. O.; Scatton, O.; Han, H. S.; Pratschke, J.; Wang, X.; Liu, R.; Goh, B. K. P. (Autor de correspondencia)
ISSN: 1068-9265
Volumen: 29
Número: 13
Páginas: 8398 - 8406
Fecha de publicación: 2022
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.