Abstract：
The advantages of the robotic approach in minimally invasive liver surgery (MILS) are still debated. This study compares the short-term outcomes between laparoscopic (LLR) and robotic (RLR) liver resections in propensity score matched cohorts.
Data regarding minimally invasive liver resections in two liver surgery units were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics. Intra- and post-operative outcomes were then compared. The difficulty of MILS was based on the IWATE criteria.
Two hundred sixty-nine patients underwent MILS between January 2014 and December 2021 (LLR = 192; RLR = 77). Propensity score matching identified 148 cases (LLR = 74; RLR = 74) consisting of compensated cirrhotic patients (100%) underwent non-anatomic resection of IWATE 1-2 class (90.5%) for a solitary tumor < 5 cm in diameter (93.2%). In such patients, RLRs had shorter operative time (227 vs. 250 min, p = 0.002), shorter Pringle\'s cumulative time (12 vs. 28 min, p < 0.0001), and less blood loss (137 vs. 209 cc, p = 0.006) vs. LLRs. Conversion rate was nihil (both groups). In RLRs compared to LLRs, R0 rate (93 vs. 96%, p > 0.71) and major morbidity (4.1 vs. 5.4%, p > 0.999) were similar, without post-operative mortality. Hospital stay was shorter in the robotic group (6.2 vs. 6.6, p = 0.0001).
This study supports the non-inferiority of RLR over LLR. In compensated cirrhotic patients underwent resection of low-to-intermediate difficulty for a solitary nodule < 5 cm, RLR was faster, with less blood loss despite the shorter hilar clamping, and required shorter hospitalization compared to LLR.
Data regarding minimally invasive liver resections in two liver surgery units were retrospectively reviewed. A propensity score matched analysis (1:1 ratio) identified two groups of patients with similar characteristics. Intra- and post-operative outcomes were then compared. The difficulty of MILS was based on the IWATE criteria.
Two hundred sixty-nine patients underwent MILS between January 2014 and December 2021 (LLR = 192; RLR = 77). Propensity score matching identified 148 cases (LLR = 74; RLR = 74) consisting of compensated cirrhotic patients (100%) underwent non-anatomic resection of IWATE 1-2 class (90.5%) for a solitary tumor < 5 cm in diameter (93.2%). In such patients, RLRs had shorter operative time (227 vs. 250 min, p = 0.002), shorter Pringle\'s cumulative time (12 vs. 28 min, p < 0.0001), and less blood loss (137 vs. 209 cc, p = 0.006) vs. LLRs. Conversion rate was nihil (both groups). In RLRs compared to LLRs, R0 rate (93 vs. 96%, p > 0.71) and major morbidity (4.1 vs. 5.4%, p > 0.999) were similar, without post-operative mortality. Hospital stay was shorter in the robotic group (6.2 vs. 6.6, p = 0.0001).
This study supports the non-inferiority of RLR over LLR. In compensated cirrhotic patients underwent resection of low-to-intermediate difficulty for a solitary nodule < 5 cm, RLR was faster, with less blood loss despite the shorter hilar clamping, and required shorter hospitalization compared to LLR.
摘要：
背景：机器人方法在微创肝脏手术（MILS）中的优势仍在争论中。这项研究比较了倾向评分匹配队列中腹腔镜（LLR）和机器人（RLR）肝切除术之间的短期结果。
方法：回顾性分析了两个肝脏外科单位的微创肝切除数据。倾向评分匹配分析（1：1比例）确定了两组具有相似特征的患者。然后比较术中和术后结果。MILS的难度基于IWATE标准。
结果：2014年1月至2021年12月期间，共有两百六十九名患者接受了MILS（LLR=192；RLR=77）。倾向评分匹配确定148例（LLR=74;RLR=74），由代偿性肝硬化患者（100％）接受非解剖切除IWATE1-2级（90.5％）的孤立性肿瘤直径<5cm（93.2％）。在这样的病人中,RLRs的手术时间较短（227vs.250分钟,p=0.002),Pringle的累积时间较短(12与28分钟,p<0.0001),减少失血（137vs.209cc,p=0.006)与LLR.转化率为nihil(两组)。在RLR与LLR相比，R0率（93与96%,p>0.71）和主要发病率（4.1vs.5.4%,p>0.999)相似，无术后死亡率。机器人组的住院时间较短（6.2vs.6.6，p=0.0001）。
结论：本研究支持RLR相对于LLR的非劣效性。在代偿性肝硬化患者中，对于<5cm的孤立性结节进行了低至中等难度的切除，RLR更快，尽管肝门夹紧时间较短，但失血量较少，与LLR相比，需要更短的住院时间。
方法：回顾性分析了两个肝脏外科单位的微创肝切除数据。倾向评分匹配分析（1：1比例）确定了两组具有相似特征的患者。然后比较术中和术后结果。MILS的难度基于IWATE标准。
结果：2014年1月至2021年12月期间，共有两百六十九名患者接受了MILS（LLR=192；RLR=77）。倾向评分匹配确定148例（LLR=74;RLR=74），由代偿性肝硬化患者（100％）接受非解剖切除IWATE1-2级（90.5％）的孤立性肿瘤直径<5cm（93.2％）。在这样的病人中,RLRs的手术时间较短（227vs.250分钟,p=0.002),Pringle的累积时间较短(12与28分钟,p<0.0001),减少失血（137vs.209cc,p=0.006)与LLR.转化率为nihil(两组)。在RLR与LLR相比，R0率（93与96%,p>0.71）和主要发病率（4.1vs.5.4%,p>0.999)相似，无术后死亡率。机器人组的住院时间较短（6.2vs.6.6，p=0.0001）。
结论：本研究支持RLR相对于LLR的非劣效性。在代偿性肝硬化患者中，对于<5cm的孤立性结节进行了低至中等难度的切除，RLR更快，尽管肝门夹紧时间较短，但失血量较少，与LLR相比，需要更短的住院时间。
