Propensity-score matched and coarsened-exact matched analysis comparing robotic and laparoscopic major hepatectomies: an international multicenter study of 4822 cases

Abstract

<h3>Objective: </h3><p>To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH).</p><h3>Background: </h3><p>Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH.</p><h3>Methods: </h3><p>This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups</p><h3>Results: </h3><p>A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; <em>P</em> = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; <em>P</em> = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; <em>P</em> < 0.001; CEM: 54.0% vs 65.0%; <em>P</em> = 0.007) and open conversion (PSM: 5.1% vs 11.9%; <em>P</em> < 0.001; CEM: 5.5% vs 10.4%, <em>P</em> = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; <em>P</em> = 0.02; CEM 10.4% vs 25.5%; <em>P</em> = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; <em>P</em> < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; <em>P</em> = 0.047].</p><h3>Conclusions: </h3><p>This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.</p>