November 23, 2022
2 minutes to read
Robotic liver dissection was shown to be safe and effective compared to open hepatectomy among patients with hepatocellular carcinoma, according to study results published in gamma surgery.
The researchers concluded that the results also showed that an automated approach may reduce morbidity rates, potentially making the treatment available to patients who would otherwise not be able to receive it due to the risk of liver decompensation.
background and methods
Data on the long-term outcomes of robotic surgery are lacking liver cancer patientsto me Fabrizio Di Benedetto, MD, PhD, Researcher in the Hepatobiliary, Pancreatic and Liver Transplantation Unit at the Universities of Modena and Reggio Emilia in Italy, and colleagues.
For this reason, the researchers performed a retrospective analysis of prospectively maintained databases from two US and two European institutions that included patients with liver cancer who underwent robotic liver resections between January 1, 2010, and September 30, 2020.
The investigators used propensity score matching at a 1:1 ratio to compare 106 patients who underwent automated hepatectomy (mean age, 66 years) with a validation cohort of 106 patients who underwent open hepatectomy (mean age, 70 years) in a European center that did not . Perform an automated liver resection.
Safety, feasibility, and oncological outcomes between the two procedures were the main outcomes.
The results showed that patients who underwent robotic hepatectomy experienced significantly longer average surgical times than those who underwent open hepatectomy (295 minutes vs. s <.001).
However, robotic hepatectomy resulted in significantly fewer average days in hospital (4 days vs 10 days; s < .001) and admission to the intensive care unit (6.6% vs. 19.8%; s = .002).
In addition, the researchers noted a lower incidence of liver failure after hepatectomy among those in the robotic liver section group (7.5% vs 28.3%; s = .001) and no grade C failures.
Furthermore, they found comparable 90-day OS rates between the robotic hepatectomy group (99.1%; 95% CI, 93.5–99.9) and the open hepatectomy group (97.1%; 95% CI, 91.3–99.1), and similar incidence rates. Cumulative death associated with tumor recurrence (8.8%; 95% CI, 3.1–18.3 vs. 10.2%; 95% CI, 4.9–17.7).
The authors reported study limitations, including the retrospective design and potential biases of the multicenter and nonrandomized protocol.
“This cohort study is, to our knowledge, the largest western series of consecutive patients treated with a complete robotic hepatectomy approach. HCCthe researchers wrote. Results show that robotic hepatectomy is associated with a better tolerance of surgery than open hepatectomy in patients with HCC after propensity score matching analysis based on clinical, oncological, and technical criteria. After propensity score matching, the two groups became homogeneous on the basis of not only baseline characteristics but also Surgical difficulty and preoperative risk of tumor recurrence, representing an important improvement in this type of analysis.”
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