Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison
Open parenchymal-preserving resection is the current standard of care for lesions in the posterosuperior liver segments. Laparoscopy and robot-assisted surgery are emergent surgical approaches for liver resections, even in posteriorly located lesions. The objective of this study was to compare robot-assisted to laparoscopic parenchymal-preserving liver resections for lesions located in segments 7, 8, 4a, and 1.
Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent laparoscopic and robot-assisted liver resection in two centers for lesions in the posterosuperior segments between June 2008 and February 2014 were reviewed. A 1:2 matched propensity score analysis was performed by individually matching patients in the robotic cohort to patients in the laparoscopic cohort based on demographics, comorbidities, performance status, tumor stage, location, and type of resection.
Thirty-six patients who underwent robot-assisted liver resection were matched with 72 patients undergoing laparoscopic liver resection. Matched patients displayed no significant differences in postoperative outcomes as measured by blood loss, hospital stay, R0 negative margin rate, and mortality. The overall morbidity according to the comprehensive complication index was also similar (34.6 ± 33 vs. 18.4 ± 11.3, respectively, for robotic and laparoscopic approach, p = 0.11). Patients undergoing robotic liver surgery had significantly longer inflow occlusion time (77 vs. 25 min, p = 0.001) as compared with their laparoscopic counterparts.
Although number and severity of complications in the robotic group appears to be higher, robotic and laparoscopic parenchymal-preserving liver resections in the posterosuperior segments display similar safety and feasibility.
KeywordsRobotic liver resections Laparoscopic liver resections Posterosuperior segments Propensity score
Roberto Montalti, Vincenzo Scuderi, Alberto Patriti, Marco Vivarelli, and Roberto I. Troisi declared that have no conflicts of interest or financial ties to disclose.
- 1.Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825-830Google Scholar
- 15.Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:99Google Scholar
- 17.Fisher SB, Kneuertz PJ, Dodson RM, Patel SH, Maithel SK, Sarmiento JM, Russell MC, Cardona K, Choti MA, Staley CA 3rd, Pawlik TM, Kooby DA (2013) A comparison of right posterior sectorectomy with formal right hepatectomy: a dual-institution study. HPB 15:753–762PubMedCentralCrossRefPubMedGoogle Scholar
- 26.Gold JS, Are C, Kornprat P, Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Blumgart LH, D’Angelica M (2008) Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients. Ann Surg 247:109–117CrossRefPubMedGoogle Scholar
- 27.Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI (2014) Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: oncological outcomes of a case–control matched-pairs analysis. Eur J Surg Oncol 40:536–544CrossRefPubMedGoogle Scholar
- 36.PS Matching in SPSS. http://sourceforge.net/projects/psmspss/
- 37.Thoemmes F (2012) Propensity score matching in SPSS. http://arxiv.org/ftp/arxiv/papers/1201/1201.6385.pdf
- 50.Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Seong Han H, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CHD, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen K-H, Schön MR, Sugioka A, Tang C-N, Herman P, Pekolj J, Chen X-P, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo C-M, Clavien P-A, Kokudo N, Barkun J, Strasberg SM (2015) Current status and recommendations for laparoscopic liver resection: a report from the 2nd international consensus conference held in IWATE. Ann Surg (In press)Google Scholar