Propensity Score-matched Analysis Comparing Robotic Versus Laparoscopic Minor Liver Resections of the Anterolateral Segments: An International Multicenter Study of 10,517 Cases

Abstract

Objective: The aim of this study was to compare the outcomes of robotic minor liver resection (RMLR) versus laparoscopic minor liver resection (LMLR) of the anterolateral segments. Background: Robotic liver surgery has been gaining prominence over the years with increasing usage for a myriad of hepatic resections. Robotic liver resection (RLR) has demonstrated noninferiority to laparoscopic resection (LR), while illustrating advantages over conventional laparoscopy especially for technically difficult and major LR. However, the advantage of RMLR for the anterolateral (AL) (segments II, III, IVb, V, and VI) segments, has not been clearly demonstrated. Methods: Between 2008 to 2022, 15,356 of 29,861 patients from 68 international centres underwent robotic minor liver resection (RMLR) or laparoscopic minor liver resection (LMLR) for the AL segments propensity score-matching (PSM) analysis was performed for matched analysis. Results: A total of 10,517 patients met the study criteria of which 1481 underwent RMLR and 9036 underwent LMLR. A PSM cohort of 1401 patients in each group were identified for analysis. Compared with the LMLR cohort, the RMLR cohort demonstrated significantly lower median blood loss (75 vs 100 mL, P <0.001), decreased blood transfusion (3.1% vs 5.4%, P =0.003), lower incidence of major morbidity (2.5% vs 4.6%, P =0.004), lower proportion of open conversion (1.2% vs 4.5%, P <0.001), shorter postoperative stay (4 vs 5 days, P <0.001), but higher rate of 30-day readmission (3.5% vs 2.1%, P =0.042). These results were then validated by a 1:2 PSM analysis. In the subset analysis for 3614 patients with cirrhosis, RMLR showed lower median blood loss, decreased blood transfusion, lower open conversion, and shorter postoperative stay than LMLR. Conclusion: RMLR demonstrated statistically significant advantages over LMLR even for resections in the AL segments although most of the observed clinical differences were minimal.