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Robotic versus open hemihepatectomy: a propensity score-matched study

机译：机器人与开放性半透明切除术：倾向分数匹配的研究

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摘要

Background Minimally invasive approach has been increasingly applied in liver resection. However, laparoscopic major hepatectomy is technically demanding and is practiced only in expert centers around the world. Conversely, use of robot may help to overcome the difficulty and facilitate major hepatectomy. Methods Between September 2010 and March 2019, 151 patients received robotic hepatectomy for various indications in our center. 36 patients received robotic hemihepatectomy: 26 left hepatectomy and 10 right hepatectomy. During the same period, 737 patients received open hepatectomy and out of these, 173 patients received open hemihepatectomy. A propensity score-matched analysis was performed in a 1:1 ratio. Results After matching, there were 36 patients each in the robotic and open group. The two groups were comparable in demographic data, type of hemihepatectomy, underlying pathology, size of tumor, and background cirrhosis. Conversion was needed in 3 patients (8.3%) in the robotic group. There was no operative mortality. The operative blood loss and resection margin were similar. Though not significantly different, there was a higher rate of complications in the robotic group (36.1% vs. 22.2%) and this difference was mostly driven by higher intra-abdominal collection (16.7% vs. 5.6%) and bile leak (5.6% vs. 2.8%). Operative time was significantly longer (400.8 +/- 136.1 min vs 255.4 +/- 74.4 min, P < 0.001) but the postoperative hospital stay was significantly shorter (median 5 days vs 6.5 days, P = 0.040) in the robotic group. When right and left hepatectomy were analyzed separately, the advantage of shorter hospital stay remained in left but not right hepatectomy. For patients with hepatocellular carcinoma, there was no difference between the two groups in 5-year overall and disease-free survival. Conclusion Compared with the open approach, robotic hemihepatectomy has longer operation time but shorter hospital stay. Thus, use of robot is feasible and effective in hemihepatectomy with the benefit of shorter hospital stay.
机译：背景微创手术在肝脏切除术中的应用越来越多。然而，腹腔镜大肝切除术在技术上要求很高，而且仅在世界各地的专家中心进行。相反，使用机器人可能有助于克服困难，促进大肝切除术。方法2010年9月至2019年3月，151名患者因各种适应症在我们中心接受了机器人肝切除术。36例患者接受了机器人半肝切除术：26例左肝切除术和10例右肝切除术。在同一时期，737名患者接受了开放式肝切除术，其中173名患者接受了开放式半肝切除术。以1:1的比例进行倾向评分匹配分析。结果匹配后，机器人组和开放组各36例。两组在人口统计学数据、半肝切除术类型、潜在病理学、肿瘤大小和背景肝硬化方面具有可比性。机器人组有3名患者（8.3%）需要转换。没有手术死亡率。手术出血量和切除范围相似。虽然没有显著差异，但机器人组的并发症发生率较高（36.1%对22.2%），这种差异主要是由较高的腹腔收集率（16.7%对5.6%）和胆漏率（5.6%对2.8%）造成的。机器人组的手术时间显著延长（400.8+/-136.1分钟vs 255.4+/-74.4分钟，P<0.001），但术后住院时间显著缩短（中位5天vs 6.5天，P=0.040）。当分别分析右肝切除术和左肝切除术时，左肝切除术的住院时间短的优势仍然存在，而右肝切除术则没有。对于肝细胞癌患者，两组的5年总生存率和无病生存率没有差异。结论与开放式肝切除术相比，机器人半肝切除术手术时间长，住院时间短。因此，在半肝切除术中使用机器人是可行和有效的，有利于缩短住院时间。

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  • 来源
    《Surgical Endoscopy》 |2021年第5期|共8页
  • 作者

    Lee Kit-fai; Chong Charing; Cheung Sunny; Wong John; Fung Andrew; Lok Hon-ting; Lo Eugene; Lai Paul;

  • 作者单位

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

    Prince Wales Hosp Dept Surg Shatin 30-32 Ngan Shing St Hong Kong Peoples R China;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Hemihepatectomy; Major hepatectomy; Robotic hepatectomy; Open hepatectomy;

    机译：半肝切除术;主要肝切除术;机器人肝切除术;开放性肝切除术;

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