OBJECTIVE To compare the outcomes of robotic minor liver resections (RMLR) versus laparoscopic (L) MLR of the anterolateral segments. BACKGROUND Robotic liver surgery has been gaining prominence over the years with increasing usage for a myriad of hepatic resections. Robotic liver resections(RLR) has demonstrated non-inferiority to laparoscopic(L)LR while illustrating advantages over conventional laparoscopy especially for technically difficult and major LR. However, the advantage of RMLR for the anterolateral(AL) (segments II, III, IVb, V and VI) segments, has not been clearly demonstrated. METHODS Between 2008 to 2022, 15,356 of 29,861 patients from 68 international centres underwent robotic(R) or laparoscopic minor liver resections (LMLR) for the AL segments Propensity score matching (PSM) analysis was performed for matched analysis. RESULTS 10,517 patients met the study criteria of which 1,481 underwent RMLR and 9,036 underwent LMLR. A PSM cohort of 1,401 patients in each group were identified for analysis. Compared to the LMLR cohort, the RMLR cohort demonstrated significantly lower median blood loss (75ml vs. 100ml, P<0.001), decreased blood transfusion (3.1% vs. 5.4%, P=0.003), lower incidence of major morbidity (2.5% vs. 4.6%, P=0.004), lower proportion of open conversion (1.2% vs. 4.5%, P<0.001), shorter post operative stay (4 days vs. 5 days, P<0.001), but higher rate of 30-day readmission (3.5% vs. 2.1%, P=0.042). These results were then validated by a 1:2 PSM analysis. In the subset analysis for 3,614 patients with cirrhosis, RMLR showed lower median blood loss, decreased blood transfusion, lower open conversion and shorter post operative stay than LMLR. CONCLUSION RMLR demonstrated statistically significant advantages over LMLR even for resections in the AL segments although most of the observed clinical differences were minimal.

中文翻译：

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比较机器人与腹腔镜前外侧段小肝切除术的倾向评分匹配分析：一项针对 10,517 例病例的国际多中心研究。


目的 比较机器人前外侧段小肝切除术 (RMLR) 与腹腔镜 (L) MLR 的结果。背景技术多年来，随着无数肝切除术的使用不断增加，机器人肝脏手术已经越来越受到重视。机器人肝切除术 (RLR) 已证明不劣于腹腔镜 (L)LR，同时也比传统腹腔镜手术具有优势，特别是对于技术难度较大的 LR。然而，RMLR 对于前外侧 (AL)（II、III、IVb、V 和 VI 段）段的优势尚未得到明确证明。方法 2008 年至 2022 年间，来自 68 个国际中心的 29,861 名患者中的 15,356 名患者接受了机器人（R）或腹腔镜小型肝切除术（LMLR）进行 AL 段倾向评分匹配（PSM）分析以进行匹配分析。结果 10,517 名患者符合研究标准，其中 1,481 名患者接受了 RMLR，9,036 名患者接受了 LMLR。确定 PSM 队列每组 1,401 名患者进行分析。与 LMLR 队列相比，RMLR 队列的中位失血量显着较低（75ml vs. 100ml，P<0.001），输血量减少（3.1% vs. 5.4%，P=0.003），主要发病率较低（ 2.5% vs. 4.6%, P=0.004)，开放转换比例较低（1.2% vs. 4.5%，P<0.001），术后停留时间较短（4 天 vs. 5 天，P<0.001） ，但 30 天再入院率较高（3.5% vs. 2.1%，P=0.042）。然后通过 1:2 PSM 分析验证这些结果。在 3,614 名肝硬化患者的子集分析中，与 LMLR 相比，RMLR 的中位失血量较低，输血量减少，开放转换率较低，术后停留时间较短。 结论 尽管大多数观察到的临床差异很小，但即使对于 AL 段的切除，RMLR 也表现出优于 LMLR 的统计学显着优势。