Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases

Abstract

Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours ≥10 cm.Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (≥10 cm) tumors at 42 international centers between 2002-2020.Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs.21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs.6 days, P=0.435).Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.

Robotic versus open resection for colorectal liver metastases in a “referral centre Hub&Spoke learning program”. A multicenter propensity score matching analysis of perioperative outcomes

“…The H&S showed a highly satisfaction rate of patients, the surgical collaboration reduced costs due to health migration especially in patients who experienced prolonged LOS and improved the earlier discharge thanks to a cropped distance from the reference care hospital. Regarding laparoscopic liver surgery, we can conclude that short- and long-terms outcomes are superimposable when compared to RLR [ 59 , [70] , [71] , [72] , [73] ]. Tsilimigras et al [ 74 ] reviewed 31 studies in order to analyze the safety and oncologic outcomes of RLR.…”

Robotic versus Laparoscopic Liver Resections for Colorectal Metastases: A Systematic Review and Meta-Analysis

“…Fifteen potentially eligible articles were assessed for full-text evaluation. The final analysis included eight trials with a total number of 3210 patients [4,[19][20][21][22][23][24][25], of whom 2680 underwent LRL and 530 underwent RLR surgery. Among those studies, one was designed as a prospective study, and seven were retrospective trials.…”

“…The articles analyzed in this meta-analysis were published between 2020 and 2023. Of the eight trials, two were performed in Italy [22,23], one in China [21], one in the USA [24], and one in Germany [4]. Three studies were international trials [19,20,25].…”

Feasibility and safety of robotic liver resection for huge (≥10 cm) hepatocellular carcinoma in a single centre: A propensity score‐matched single‐surgeon study

“…laparoscopic surgery, achieving a higher overall survival rate. 8 Through refined techniques and extensive surgical experience, the minimally invasive resection of huge tumours has become increasingly feasible. This study aimed to assess the feasibility and safety of robot-assisted laparoscopic resection for huge HCCs (≥10 cm) by comparing them with a matched control group (1-9 cm) using propensity score matching (PSM) methods.…”