PDF(Pubmed)
Abstract：
BACKGROUND: In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS.
METHODS: The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications.
RESULTS: Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56).
CONCLUSIONS: Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.
METHODS: The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications.
RESULTS: Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56).
CONCLUSIONS: Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.
摘要：
背景：在主要不可切除的肝肿瘤中，ALPPS（联合肝分区和门静脉结扎用于分期肝切除术）可以提供治愈性的两阶段肝切除术，通过快速和广泛的肥大。然而,人们对该程序的侵入性提出了担忧。全机器人ALPPS有可能通过侵入性较小的途径降低术后发病率。这项研究的目的是比较开放式和全机器人ALPPS的围手术期结果。
方法：双中心研究包括来自苏黎世大学医院的开放性ALPPS病例，瑞士和来自摩德纳大学和雷焦艾米利亚的机器人ALPPS病例，意大利从01/2015到07/2022。主要结果是术中参数和总体并发症。
结果：36例和7例进行了开放式和全机器人ALPPS。机器人ALPPS与两个阶段后的失血量减少有关（418±237ml与319±197ml；P=0.04和631±354ml与258±53ml；P=0.01）以及更高的级间放电率（86％vs.37%；P=0.02）。两个阶段后，机器人ALPPS的OT时间更长（371±70分钟vs.449±81分钟；P=0.01和282±87分钟vs.373±90分钟；P=0.02）。ALPPS2期后，总体并发症没有差异(86%与86％；P=1.00）和主要并发症（43％vs.39%；P=0.86）。总住院时间相似(23±17天vs.26±13；P=0.56）。
结论：在有经验的机器人中心，与开放式ALPPS相比，机器人ALPPS是安全实施的，并显示出改善围手术期结局的潜力。机器人方法可能使ALPPS的围手术期风险状况更接近门静脉栓塞/肝静脉剥夺的介入技术。
方法：双中心研究包括来自苏黎世大学医院的开放性ALPPS病例，瑞士和来自摩德纳大学和雷焦艾米利亚的机器人ALPPS病例，意大利从01/2015到07/2022。主要结果是术中参数和总体并发症。
结果：36例和7例进行了开放式和全机器人ALPPS。机器人ALPPS与两个阶段后的失血量减少有关（418±237ml与319±197ml；P=0.04和631±354ml与258±53ml；P=0.01）以及更高的级间放电率（86％vs.37%；P=0.02）。两个阶段后，机器人ALPPS的OT时间更长（371±70分钟vs.449±81分钟；P=0.01和282±87分钟vs.373±90分钟；P=0.02）。ALPPS2期后，总体并发症没有差异(86%与86％；P=1.00）和主要并发症（43％vs.39%；P=0.86）。总住院时间相似(23±17天vs.26±13；P=0.56）。
结论：在有经验的机器人中心，与开放式ALPPS相比，机器人ALPPS是安全实施的，并显示出改善围手术期结局的潜力。机器人方法可能使ALPPS的围手术期风险状况更接近门静脉栓塞/肝静脉剥夺的介入技术。
