Skip to main content
SpringerLink
Log in

Propensity score matched comparison of robotic and open major hepatectomy for malignant liver tumors

  • 2021 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Outcome data on robotic major hepatectomy are lacking. This study was undertaken to compare robotic vs. ‘open’ major hepatectomy utilizing patient propensity score matching (PSM).

Methods

With institutional review board approval, we prospectively followed 183 consecutive patients who underwent robotic or ‘open’ major hepatectomy, defined as removal of three or more Couinaud segments. 42 patients who underwent ‘open’ approach were matched with 42 patients who underwent robotic approach. The criteria for PSM were age, resection type, tumor size, tumor type, and BMI. Survival was individually stratified for hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHCC), and colorectal liver metastases (CLM). The data are presented as: median (mean ± SD).

Results

Operative duration for the robotic approach was 293 (302 ± 131.5) vs. 280 (300 ± 115.6) minutes for the ‘open’ approach (p = NS). Estimated Blood Loss (EBL) was 200 (239 ± 183.6) vs. 300 (491 ± 577.1) ml (p = 0.01). There were zero postoperative complications with a Clavien–Dindo classification ≥ III for the robotic approach and three for the ‘open’ approach (p = NS). ICU length of stay (LOS) was 1 (1 ± 0) vs. 2 (3 ± 2.0) days (p = 0.0001) and overall LOS was 4 (4 ± 3.3) vs. 6 (6 ± 2.7) days (p = 0.003). In terms of long-term oncological outcomes, overall survival was similar for patients with IHCC and CLM regardless of the approach. However, patients with HCC who underwent robotic resection lived significantly longer (p = 0.05).

Conclusion

Utilizing propensity score matched analysis, the robotic approach was associated with a lower EBL, shorter ICU LOS, and shorter overall LOS while maintaining similar operative duration and promoting survival in patients with HCC. We believe that the robotic approach is safe and efficacious and should be considered a preferred alternative approach for major hepatectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Aghayan DL, Kazaryan AM, Dagenborg VJ, Røsok BI, Fagerland MW, Waaler Bjørnelv GM, Kristiansen R, Flatmark K et al (2021) Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases : a randomized trial. Ann Intern Med 174:175–182. https://doi.org/10.7326/M20-4011

    Article  PubMed  Google Scholar 

  2. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tønnessen TI et al (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207. https://doi.org/10.1097/SLA.0000000000002353

    Article  PubMed  Google Scholar 

  3. Kwon Y, Cho JY, Han H-S, Yoon Y-S, Lee HW, Lee JS, Lee B, Kim M (2021) Improved outcomes of laparoscopic liver resection for hepatocellular carcinoma located in posterosuperior segments of the liver. World J Surg 45:1178–1185. https://doi.org/10.1007/s00268-020-05912-5

    Article  PubMed  Google Scholar 

  4. Goh BKP (2020) Letter regarding ‘benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers.’ J Hepatol 73:1576. https://doi.org/10.1016/j.jhep.2020.07.002

    Article  PubMed  Google Scholar 

  5. Stewart C, Wong P, Warner S, Raoof M, Singh G, Fong Y, Melstrom L (2021) Robotic minor hepatectomy: optimizing outcomes and cost of care. HPB (Oxford) 23:700–706. https://doi.org/10.1016/j.hpb.2020.09.005

    Article  Google Scholar 

  6. Sucandy I, Luberice K, Lippert T, Castro M, Krill E, Ross S, Rosemurgy A (2020) Robotic major hepatectomy: an institutional experience and clinical outcomes. Ann Surg Oncol 27:4970–4979. https://doi.org/10.1245/s10434-020-08845-4

    Article  PubMed  Google Scholar 

  7. Sucandy I, Luberice K, Rivera-Espineira G, Krill E, Castro M, Bourdeau T, Ross S, Rosemurgy A (2021) Robotic major hepatectomy: influence of age on clinical outcomes. Am Surg 87:114–119. https://doi.org/10.1177/0003134820945249

    Article  PubMed  Google Scholar 

  8. Sucandy I, Durrani H, Ross S, Rosemurgy A (2019) Technical approach of robotic total right hepatic lobectomy: how we do it? J Robot Surg 13:193–199. https://doi.org/10.1007/s11701-018-0881-7

    Article  PubMed  Google Scholar 

  9. Sucandy I, Gravetz A, Ross S, Rosemurgy A (2019) Technique of robotic left hepatectomy: how we approach it. J Robot Surg 13:201–207. https://doi.org/10.1007/s11701-018-0890-6

    Article  PubMed  Google Scholar 

  10. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tønnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Røsok BI, Bjørnbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207. https://doi.org/10.1097/SLA.0000000000002353

    Article  PubMed  Google Scholar 

  11. Cariani E, Pilli M, Zerbini A, Rota C, Olivani A, Pelosi G, Schianchi C, Soliani P, Campanini N, Silini EM, Trenti T, Ferrari C, Missale G (2012) Immunological and molecular correlates of disease recurrence after liver resection for hepatocellular carcinoma. PLoS ONE 7:e32493. https://doi.org/10.1371/journal.pone.0032493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Refolo MG, Messa C, Guerra V, Carr BI, D’Alessandro R (2020) Inflammatory mechanisms of HCC development. Cancers (Basel). https://doi.org/10.3390/cancers12030641

    Article  Google Scholar 

  13. Yeh C-C, Lin J-T, Jeng L-B, Ho HJ, Yang H-R, Wu M-S, Kuo KN, Wu C-Y (2015) Nonsteroidal anti-inflammatory drugs are associated with reduced risk of early hepatocellular carcinoma recurrence after curative liver resection: a nationwide cohort study. Ann Surg 261:521–526. https://doi.org/10.1097/SLA.0000000000000746

    Article  PubMed  Google Scholar 

  14. Shu Z-B, Cao H-P, Li Y-C, Sun L-B (2015) Influences of laparoscopic-assisted gastrectomy and open gastrectomy on serum interleukin-6 levels in patients with gastric cancer among Asian populations: a systematic review. BMC Gastroenterol 15:52. https://doi.org/10.1186/s12876-015-0276-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Zhang H, Tong J-J, Zhang Z-N, Wang H-B, Zhang Y-H (2021) Laparoscopic left hemihepatectomy combined with right lateral hepatic lobectomy in pigs: surgical approach and comparative study of the inflammatory response versus open surgery. Vet Res Forum 12:1–6

    PubMed  PubMed Central  Google Scholar 

  16. Tabrizian P, Jibara G, Shrager B, Schwartz M, Roayaie S (2015) Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg 261:947–955. https://doi.org/10.1097/SLA.0000000000000710

    Article  PubMed  Google Scholar 

  17. Boshier PR, Ziff C, Adam ME, Fehervari M, Markar SR, Hanna GB (2018) Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis. Dis Esophagus. https://doi.org/10.1093/dote/dox134

    Article  PubMed  Google Scholar 

  18. Qian S, Golubnitschaja O, Zhan X (2019) Chronic inflammation: key player and biomarker-set to predict and prevent cancer development and progression based on individualized patient profiles. EPMA J 10:365–381. https://doi.org/10.1007/s13167-019-00194-x

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yu G, Tang B, Yu P-W, Peng Z-H, Qian F, Sun G (2010) Systemic and peritoneal inflammatory response after laparoscopic-assisted gastrectomy and the effect of inflammatory cytokines on adhesion of gastric cancer cells to peritoneal mesothelial cells. Surg Endosc 24:2860–2870. https://doi.org/10.1007/s00464-010-1067-1

    Article  PubMed  Google Scholar 

  20. Nota CL, Woo Y, Raoof M, Boerner T, Molenaar IQ, Choi GH, Kingham TP, Latorre K, Borel Rinkes IHM, Hagendoorn J, Fong Y (2019) Robotic versus open minor liver resections of the posterosuperior segments: a multinational, propensity score-matched study. Ann Surg Oncol 26:583–590. https://doi.org/10.1245/s10434-018-6928-1

    Article  PubMed  Google Scholar 

  21. Bagante F, Spolverato G, Strasberg SM, Gani F, Thompson V, Hall BL, Bentrem DJ, Pitt HA, Pawlik TM (2016) Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database. J Gastrointest Surg 20:1608–1617. https://doi.org/10.1007/s11605-016-3202-3

    Article  PubMed  Google Scholar 

  22. Tee MC, Chen L, Peightal D, Franko J, Kim PT, Brahmbhatt RD, Raman S, Scudamore CH, Chung SW, Segedi M (2020) Minimally invasive hepatectomy is associated with decreased morbidity and resource utilization in the elderly. Surg Endosc 34:5030–5040. https://doi.org/10.1007/s00464-019-07298-5

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

None.

Author information

Authors and Affiliations

  1. Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA

    Iswanto Sucandy, Emanuel Shapera, Cameron C. Syblis, Kaitlyn Crespo, Valerie A. Przetocki, Sharona B. Ross & Alexander S. Rosemurgy

Authors
  1. Iswanto Sucandy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuel Shapera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cameron C. Syblis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kaitlyn Crespo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valerie A. Przetocki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sharona B. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexander S. Rosemurgy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iswanto Sucandy.

Ethics declarations

Disclosures

Iswanto Sucandy, Emanuel Shapera, Cameron C. Syblis, Kaitlyn Crespo, Valerie A. Przetocki: Nothing to disclose. Sharona B. Ross: Reports personal fees and non-financial support from Intuitive Surgical Incorporated, outside the submitted work. Alexander S. Rosemurgy: Reports personal fees and non-financial support from Intuitive Surgical Incorporated, outside the submitted work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sucandy, I., Shapera, E., Syblis, C.C. et al. Propensity score matched comparison of robotic and open major hepatectomy for malignant liver tumors. Surg Endosc 36, 6724–6732 (2022). https://doi.org/10.1007/s00464-021-08948-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08948-3

Search

Navigation