使用倾向性分数匹配和粗糙精确匹配分析比较机器人和腹腔镜大肝切除术：4822例国际多中心研究。
Propensity-score Matched and Coarsened-exact Matched Analysis Comparing Robotic and Laparoscopic Major Hepatectomies: An International Multicenter Study of 4822 Cases.
发表日期：2023 Apr 14
作者：
Qu Liu, Wanguang Zhang, Joseph J Zhao, Nicholas L Syn, Federica Cipriani, Mohammad Alzoubi, Davit L Aghayan, Tiing-Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Bernardo Dalla Valle, Andrea Ruzzenente, Chee-Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Moritz Schmelzle, Johann Pratschke, Chung-Ngai Tang, Charing C N Chong, Kit-Fai Lee, Juul Meurs, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Mansour Saleh, Daniel Cherqui, Junhao Zheng, Xiao Liang, Alessandro Mazzotta, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Mizelle D'Silva, Ho-Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Bjørn Edwin, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Rong Liu, Brian K P Goh,
来源：
ANNALS OF SURGERY
摘要：
比较机器人肝大切除术（R-MH）和腹腔镜肝大切除术（L-MH）的结果。机器人技术可能能够克服腹腔镜肝切除的局限性。然而，是否机器人肝大切除术（R-MH）优于腹腔镜肝大切除术（L-MH）尚不清楚。本研究是对在2008年至2021年期间在59个国际中心接受R-MH或L-MH的患者进行的多中心数据库事后分析。收集和分析了患者人口统计学、中心经验/数量、围手术期结果和肿瘤特征的数据。对1：1倾向性评分匹配（PSM）和粗略匹配（CEM）进行了分析，以减少两组之间的选择偏差。共有4822个病例符合研究标准，其中892个接受了R-MH，3930个接受了L-MH。分别进行了1：1 PSM（841 R-MH vs. 841 L-MH）和CEM（237 R-MH vs. 356 L-MH）。与L-MH相比，R-MH与明显较少的失血量（PSM：200.0 [IQR：100.0, 450.0] ml vs. 300.0 [IQR：150.0, 500.0] ml；P=0.012；CEM：170.0 [IQR：90.0, 400.0] ml vs. 200.0 [IQR：100.0, 400.0] ml；P=0.006）、更低的普林格操作应用率（PSM：47.1% vs. 63.0%；P<0.001；CEM：54.0% vs 65.0%；P=0.007）和开放性转化率（PSM：5.1% vs. 11.9%；P<0.001；CEM：5.5% vs. 10.4%；P=0.04）有关。在1273名肝硬化患者的亚组分析中，R-MH与较低的术后并发症发生率（PSM：19.5% vs. 29.9%；P=0.02；CEM 10.4% vs. 25.5%；P=0.02）和较短的术后住院时间（PSM：6.9 [IQR：5.0, 9.0] 天 vs. 8.0 [IQR：6.0 11.3] 天；P<0.001；CEM 7.0 [IQR：5.0, 9.0] 天 vs. 7.0 [IQR：6.0, 10.0] 天；P=0.047）有关。这项国际多中心研究表明，R-MH在安全性方面与L-MH相当，并且与减少失血量、较低的普林格操作应用率和转换为开放手术有关。版权所有©2023 Wolters Kluwer Health，Inc.。保留所有权利。
To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy(L-MH).Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether robotic major hepatectomy (R-MH) is superior to laparoscopic major hepatectomy (L-MH).This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience/ volume, perioperative outcomes and tumor characteristics were collected and analyzed. 1:1 propensity score matched (PSM) and coarsened-exact matched (CEM) analysis was performed to minimize selection bias between both groups.A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM, (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss (PSM:200.0 [IQR:100.0, 450.0] ml vs. 300.0 [IQR:150.0, 500.0] ml; P=0.012; CEM:170.0 [IQR: 90.0, 400.0] ml vs. 200.0 [IQR:100.0, 400.0] ml; P=0.006), lower rates of Pringle maneuver application (PSM: 47.1% vs. 63.0%; P<0.001; CEM: 54.0% vs 65.0%; P=0.007) and open conversion (PSM: 5.1% vs. 11.9%; P<0.001; CEM: 5.5% vs. 10.4%, P=0.04) compared to L-MH. On subset analysis of 1273 cirrhotic patients, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs. 29.9%; P=0.02; CEM 10.4% vs. 25.5%; P=0.02) and shorter postoperative stay (PSM: 6.9 [IQR: 5.0, 9.0] days vs. 8.0 [IQR: 6.0 11.3] days; P<0.001; CEM 7.0 [IQR: 5.0, 9.0] days vs. 7.0 [IQR: 6.0, 10.0] days; P=0.047).This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application and conversion to open surgery.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.