Fabrizio Di Benedetto, Paolo Magistri, Marcus Yeow, Davit L Aghayan, Cheng Yao, Takeashi Ishizawa, Federica Cipriani, Wanguang Zhang, Olivier Scatton, Fabricio Ferreira Coelho, Safi Dokmak, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Motokazu Sugimoto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Kiyoshi Hasegawa, Roland S Croner, Salvatore Gruttadauria, Jason Hawksworth, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Chung-Ngai Tang, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Daniel Cherqui, Xiao Liang, Soufyan El Adel, Rutger-Jan Swijnenburg, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Atsushi Sugioka, Ismail Labgaa, Moritz Schmelzle, Etsuro Hatano, Alejandro Mejia, Marco V Marino, Umberto Cillo, Chengzhan Zhu, Tran Cong Duy Long, Yufu Peng, Yonggang Wei, Rong Liu, Ho-Seong Han, Olivier Soubrane, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Francesca Ratti, Bjørn Edwin, Brian K P Goh, International Robotic and Laparoscopic Liver Resection Study Group Investigators
Both robotic liver resection and laparoscopic liver resection can be performed safely in selected patients with cirrhosis and clinically significant portal hypertension. Robotic liver resection was associated with lower postoperative morbidity.
BACKGROUND: Minimally invasive liver resection is increasingly performed, even in patients with cirrhosis and clinically significant portal hypertension. However, the benefits of robotic liver resection over laparoscopic liver resection in patients with cirrhosis and clinically significant portal hypertension remain unclear.
METHODS: We conducted a post hoc international, multicenter study including 2,328 patients with cirrhosis and clinically significant portal hypertension who underwent minimally invasive liver resection (2,004 laparoscopic liver resection and 324 robotic liver resection). Propensity score matching was performed in 1:1 and 2:1 ratios to compare perioperative outcomes between the 2 approaches. A mixed-effects logistic regression model with center as a random effect was additionally applied to the full unmatched cohort as a complementary analysis to account for center-level clustering.
RESULTS: After 1:1 propensity score matching (n = 287 per group), robotic liver resection was associated with significantly shorter operative time (180 vs 210 minutes, P = .002), reduced estimated blood loss (100 vs 200 mL, P < .001), lower open conversion rate (3.8% vs 9.2%, P = .012), lower postoperative morbidity rate (15% vs 26.5%, P = .002), and shorter postoperative stay (5 vs 6 days, P < .001). However, mixed-effects logistic regression on the entire unmatched cohort demonstrated that robotic liver resection was only associated with a significantly lower postoperative morbidity at the expense of a longer operation time.
CONCLUSION: Both robotic liver resection and laparoscopic liver resection can be performed safely in selected patients with cirrhosis and clinically significant portal hypertension. Robotic liver resection was associated with lower postoperative morbidity.