Background

Following the publication of reports from landmark international consensuses (Louisville 2008 and Morioka 2014), minimally invasive hepatectomy became widely accepted as a legitimate alternative to open surgery. We aimed to compare the operative, hospitalization, and total economic costs of open (OLR) vs. laparoscopic (LLR) vs. robotic liver resection (RLR).

Methods

We performed a systematic literature review (end-of-search date: July 3, 2020) according to the PRISMA statement. Random-effects meta-analyses were conducted. Quality assessment was performed with the Cochrane Risk of Bias tool for randomized controlled trials, and the Newcastle–Ottawa Scale for non-randomized studies.

Results

Thirty-eight studies reporting on 3847 patients (1783 OLR; 1674 LLR; 390 RLR) were included. The operative costs of LLR were significantly higher than those of OLR, while subgroup analysis also showed higher operative costs in the LLR group for major hepatectomy, but no statistically significant difference for minor hepatectomy. Hospitalization costs were significantly lower in the LLR group, with subgroup analyses indicating lower costs for LLR in both major and minor hepatectomy series. No statistically significant difference was observed regarding total costs between LLR and OLR both overall and on subgroup analyses in either major or minor hepatectomy series. Meta-analyses showed higher operative, hospitalization, and total costs for RLR vs. LLR, but no statistically significant difference regarding total costs for RLR vs. OLR.

Conclusion

LLR’s higher operative costs are offset by lower hospitalization costs compared to OLR leading to no statistically significant difference in total costs, while RLR appears to be a more expensive alternative approach.

中文翻译：

---

开腹与腹腔镜与机器人肝切除术的经济分析：系统评价和荟萃分析

背景

在具有里程碑意义的国际共识（Louisville 2008 和 Morioka 2014）的报告发表后，微创肝切除术被广泛接受为开放手术的合法替代方案。我们旨在比较开放 (OLR) 与腹腔镜 (LLR) 与机器人肝切除术 (RLR) 的手术、住院和总经济成本。

方法

我们根据 PRISMA 声明进行了系统的文献回顾（检索结束日期：2020 年 7 月 3 日）。进行了随机效应荟萃分析。随机对照试验使用 Cochrane 偏倚风险工具进行质量评估，非随机研究使用 Newcastle-Ottawa 量表进行质量评估。

结果

38 项研究报告了 3847 名患者（1783 名 OLR；1674 名 LLR；390 名 RLR）。LLR的手术费用显着高于OLR，而亚组分析也显示LLR组大肝切除术的手术费用较高，但小肝切除术无统计学差异。LLR 组的住院费用显着降低，亚组分析表明，在主要和次要肝切除术系列中，LLR 的费用较低。在主要或次要肝切除术系列的整体和亚组分析中，LLR 和 OLR 之间的总成本没有观察到统计学上的显着差异。荟萃分析显示，RLR 与 LLR 的手术、住院和总成本更高，但 RLR 与 OLR 的总成本无统计学差异。

结论

与 OLR 相比，LLR 较高的手术费用被较低的住院费用所抵消，导致总费用在统计学上没有显着差异，而 RLR 似乎是一种更昂贵的替代方法。