Comparison between minimally invasive right anterior and right posterior sectionectomy vs right hepatectomy: An international multicenter propensity score-matched and coarsened-exact-matched analysis of 1,100 patients Journal Article
| Authors: | Willems, E.; D'Hondt, M.; Kingham, T. P.; Fuks, D.; Choi, G. H.; Syn, N. L.; Sucandy, I.; Marino, M. V.; Prieto, M.; Chong, C. C.; Lee, J. H.; Efanov, M.; Chiow, A. K. H.; Choi, S. H.; Sutcliffe, R. P.; Troisi, R. I.; Pratschke, J.; Cheung, T. T.; Wang, X.; Tang, C. N.; Liu, R.; Han, H. S.; Goh, B. K. P.; International Robotic and Laparoscopic Liver Resection Study Group Investigators |
| Article Title: | Comparison between minimally invasive right anterior and right posterior sectionectomy vs right hepatectomy: An international multicenter propensity score-matched and coarsened-exact-matched analysis of 1,100 patients |
| Abstract: | BACKGROUND: The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy. STUDY DESIGN: This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact-matched analysis was performed. RESULTS: A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching. CONCLUSIONS: Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients. Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | treatment outcome; retrospective studies; clinical trial; liver neoplasms; laparoscopy; retrospective study; postoperative complication; postoperative complications; length of stay; multicenter study; liver tumor; hepatectomy; procedures; propensity score; humans; human |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 235 |
| Issue: | 6 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2022-12-01 |
| Start Page: | 859 |
| End Page: | 868 |
| Language: | English |
| DOI: | 10.1097/xcs.0000000000000394 |
| PUBMED: | 36102506 |
| PROVIDER: | scopus |
| PMCID: | PMC9720542 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
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