Short- and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study

Liu, Rong

doi:10.1007/s00464-022-09236-4

Cited by 17 publications

(19 citation statements)

References 36 publications

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“…In the literature, it is commonly stated that robotic liver surgery is associated with less blood loss when compared to open liver surgery [ 4 , 5 , 39 ]. Proponents of the robot have suggested that the improved dexterity of the robotic approach would also make it superior, in terms of blood loss, when compared to the laparoscopic approach.…”

Section: Intraoperative Outcomesmentioning

confidence: 99%

“…Fortunately, the rate of post hepatectomy liver failure has decreased in the current era, especially following the introduction of minimally invasive approaches [ 64 , 65 ]. Zhang et al even reported zero liver failure following robotic liver resections, versus 0.6% liver failure in the open liver resection group, in their propensity score matched study [ 4 ]. In a study by Tee et al including only elderly patients, the grade B/C liver failure rates were significantly different following open and minimally invasive resections (4.84% versus 0.41%, respectively) [ 61 ].…”

Section: Postoperative Outcomesmentioning

confidence: 99%

“…In this context, less postoperative pain, less bleeding, a lower surgical site infection rate and a shorter hospital stay are commonly mentioned advantages. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still very much a matter of debate [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Bozkurt

Sijberden

Hilal

2022

Cancers

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In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. This review aims to summarize the currently available evidence and prospects of robotic liver surgery. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still a matter of debate. In the current literature, robotic liver surgery has mainly been associated with non-inferior outcomes compared to laparoscopy, although it is suggested that the robotic approach has a shorter learning curve, lower conversion rates, and less intraoperative blood loss. Robotic surgical systems offer a more realistic image with integrated 3D systems. In addition, the improved dexterity offered by robotic surgical systems can lead to improved intra and postoperative outcomes. In the future, integrated and improved haptic feedback mechanisms, artificial intelligence, and the introduction of more liver-specific dissectors will likely be implemented, further enhancing the robots’ abilities.

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Section: Intraoperative Outcomesmentioning

confidence: 99%

Section: Postoperative Outcomesmentioning

confidence: 99%

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What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Bozkurt

Sijberden

Hilal

2022

Cancers

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“…The sample size of the cohort undergoing MIS was relatively small, although comparable with other studies reported from Europe and Asia. [32][33][34][35] Moreover, county-level data may not allow for granular analysis of variations in poverty within smaller geographical areas such as neighborhoods and census tracts.…”

Section: Discussionmentioning

confidence: 99%

Persistent poverty impacts access to minimally invasive surgery among patients with hepatopancreatobiliary cancer

Rawicz‐Pruszyński

Woldesenbet

Endo

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesMinimally invasive surgery (MIS) has been successfully adopted in hepatopancreatobiliary (HPB) cancer, and has been associated with improved perioperative and comparable oncological outcomes. We sought to define the impact of county‐level duration of poverty on access to MIS and clinical outcomes among patients with HPB cancer undergoing surgical treatment.Materials and MethodsData on patients diagnosed with HPB cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare data (2010–2016). County‐level poverty data were obtained from the American Community Survey and the U.S. Department of Agriculture, and categorized into three groups: never high poverty (NHP), intermittent high poverty (IHP), and persistent poverty (PP). Multivariable regression was used to assess the relationship between PP and MIS.ResultsAmong 8098 patients, 82% (n = 664) resided in regions with NHP, 13.6% (n = 1104) resided in regions with IHP, and 4.4% (n = 350) resided in regions with PP. Median age at the diagnosis was 71 years (interquartile range [IQR]: 67–77). Patients from IHP and PP counties had lower odds of undergoing MIS (IHP/PP vs. NHP, odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.36–0.96, p = 0.034) and being discharged home (IHP/PP vs. NHP, OR: 0.64, 95% CI: 0.43–0.99, p = 0.043), as well as a higher risk of 1‐year mortality (IHP/PP vs. NHP, HR: 1.51, 95% CI: 1.036–2.209, p = 0.032) compared with patients residing in NHP counties.ConclusionsDuration of county‐level poverty was associated with lower receipt of MIS and unfavorable clinical and survival outcomes among patients with HPB cancer. There is a need to improve access to modern surgical treatment options among vulnerable, PP populations.

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“…Another interesting finding of our study is that liver resection is safe for elderly patients (>75 yrs) and leads to long-term survival rates similar to those of younger patients [ 60 , 61 ].…”

Section: Discussionmentioning

confidence: 77%

Individualized Approach in the Surgical Management of Hepatocellular Carcinoma: Results from a Greek Multicentre Study

Glantzounis

Korkolis

Sotiropoulos

et al. 2022

Cancers

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Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of death worldwide. The management of HCC is complex, with surgical treatment providing long-term survival in eligible patients. This study aims to present the experience of aggressive surgical management of HCC in Greece. Methods: This is a retrospective multicentre clinical study with 242 patients. Results: Most patients were male (79%) and had a median age of 71 yrs. According to the most recent BCLC criteria, 172 patients (71.1%) were classified as BCLC 0-A stage, 33 patients (13.6%) were classified as BCLC B, and 37 (15.3%) were classified as BCLC C. A total of 54% of the patients underwent major hepatectomy. Major postoperative morbidity was 15.6%, and the 90-day postoperative mortality rate was 4.5%. The median follow-up was 33.5 months. Three- and five-year overall survival was 65% and 48%, respectively. The median overall survival was 55 months. Significantly, five-year survival was 55% for BCLC A, and 34% and 21% for BCLC B and C, respectively. In univariate analysis, cirrhosis, type of resection (R status), and BCLC stage were associated with overall survival. Multivariate analysis indicated that R1 and R2 resections compared to R0, and BCLC C compared to BCLC 0-A, were independently associated with increased mortality. Conclusions: Aggressive surgical treatment of HCC offers satisfactory long-term survival prospects. A significant percentage (29%) of HCCs that underwent liver resection were of the intermediate and advanced BCLC stage. The management of patients with HCC should be discussed in multidisciplinary tumour board meetings on a case-by-case basis to be more effective.

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Short- and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study

Cited by 17 publications

References 36 publications

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

Persistent poverty impacts access to minimally invasive surgery among patients with hepatopancreatobiliary cancer

Individualized Approach in the Surgical Management of Hepatocellular Carcinoma: Results from a Greek Multicentre Study

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