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Abstract：
UNASSIGNED: Surgical resection is still considered the optimal treatment for colorectal liver metastasis (CRLM). Although laparoscopic and robotic surgery demonstrated their reliability especially in referral centers, the comparison between perioperative outcomes of robotic liver resection (RLR) and open (OLR) liver resection are still debated when performed in referral centers for robotic surgery, not dedicated to HPB. Our study aimed to verify the efficacy and safety of perioperative outcomes after RLR and OLR for CRLM in an HUB&Spoke learning program (H&S) between a high volume center for liver surgery and high volume center for robotic surgery.
UNASSIGNED: We analyzed prospective databases of Pineta Grande Hospital (Castel Volturno) and Robotic Surgical Units (Foligno-Spoleto and Arezzo) from 2011 to 2021. A 1:1 propensity score matching (PSM) was performed according to baseline characteristics of patients, solitary/multiple CRLM, anterolateral/posterosuperior location.
UNASSIGNED: 383 patients accepted to be part of the study (268 ORL and 115 RLR). After PSM, 45 patients from each group were included. Conversion rate was 8.89 %. RLR group had a significantly lower blood loss (226 vs. 321 ml; p=0.0001), and fewer major complications (13.33 % vs. 17.78 %; p=0.7722). R0 resection was obtained in 100% of OLR (vs.95.55%, p =0.4944. Hospital stay was 8.8 days in RLR (vs. 15; p=0.0001).Conclusion: H&S represents a safe and effective program to train general surgeons also in Hepatobiliary surgery providing R0 resection rate, blood loss volume and morbidity rate superimposable to referral centers. Furthermore, H&S allow a reduction of health mobility with consequent money saving for patients and institutions.
UNASSIGNED: We analyzed prospective databases of Pineta Grande Hospital (Castel Volturno) and Robotic Surgical Units (Foligno-Spoleto and Arezzo) from 2011 to 2021. A 1:1 propensity score matching (PSM) was performed according to baseline characteristics of patients, solitary/multiple CRLM, anterolateral/posterosuperior location.
UNASSIGNED: 383 patients accepted to be part of the study (268 ORL and 115 RLR). After PSM, 45 patients from each group were included. Conversion rate was 8.89 %. RLR group had a significantly lower blood loss (226 vs. 321 ml; p=0.0001), and fewer major complications (13.33 % vs. 17.78 %; p=0.7722). R0 resection was obtained in 100% of OLR (vs.95.55%, p =0.4944. Hospital stay was 8.8 days in RLR (vs. 15; p=0.0001).Conclusion: H&S represents a safe and effective program to train general surgeons also in Hepatobiliary surgery providing R0 resection rate, blood loss volume and morbidity rate superimposable to referral centers. Furthermore, H&S allow a reduction of health mobility with consequent money saving for patients and institutions.
摘要：
■手术切除仍被认为是结直肠肝转移（CRLM）的最佳治疗方法。尽管腹腔镜和机器人手术证明了它们的可靠性，尤其是在转诊中心，在机器人手术转诊中心进行时，机器人肝切除术（RLR）和开放式（OLR）肝切除术的围手术期结果之间的比较仍存在争议，不专用于HPB。我们的研究旨在验证在高容量肝脏手术中心和高容量机器人手术中心之间的HUB和辐条学习计划（H＆S）中RLR和OLRCRLM围手术期结果的有效性和安全性。
■我们分析了2011年至2021年PinetaGrande医院（CastelVolturno）和机器人外科手术单位（Foligno-Spoleto和Arezzo）的前瞻性数据库。根据患者的基线特征进行1：1倾向评分匹配（PSM），孤立/多重CRLM，前外侧/后上位置。
■383名患者被接受为研究的一部分（268ORL和115RLR）。PSM之后,每组45例患者。转化率为8.89%。RLR组的失血量明显降低（226vs.321毫升；p=0.0001），和较少的主要并发症（13.33%vs.17.78%；p=0.7722）。在100%的OLR中获得了R0切除(vs.95.55%，p=0.4944。在RLR中住院时间为8.8天（与15；p=0.0001）。结论：H＆S代表了一种安全有效的计划，可以在提供R0切除率的肝胆外科手术中培训普通外科医生，转诊中心可叠加的失血量和发病率。此外，H＆S可以减少健康流动性，从而为患者和机构节省资金。
■我们分析了2011年至2021年PinetaGrande医院（CastelVolturno）和机器人外科手术单位（Foligno-Spoleto和Arezzo）的前瞻性数据库。根据患者的基线特征进行1：1倾向评分匹配（PSM），孤立/多重CRLM，前外侧/后上位置。
■383名患者被接受为研究的一部分（268ORL和115RLR）。PSM之后,每组45例患者。转化率为8.89%。RLR组的失血量明显降低（226vs.321毫升；p=0.0001），和较少的主要并发症（13.33%vs.17.78%；p=0.7722）。在100%的OLR中获得了R0切除(vs.95.55%，p=0.4944。在RLR中住院时间为8.8天（与15；p=0.0001）。结论：H＆S代表了一种安全有效的计划，可以在提供R0切除率的肝胆外科手术中培训普通外科医生，转诊中心可叠加的失血量和发病率。此外，H＆S可以减少健康流动性，从而为患者和机构节省资金。
