AbstractBackgroundLimited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).MethodsThis was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.ResultsOf 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40–200) versus 200 (100–500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20–46) versus 40 (25–58) min; P = 0.012), and median duration of operation (175 (130–255) versus 224 (155–300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.ConclusionBased on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.

中文翻译：

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后上段的有限肝脏切除：比较腹腔镜和机器人方法的国际多中心倾向评分匹配和粗化精确匹配分析

摘要背景针对位于肝脏后上段的肿瘤进行有限肝切除术 (LLR) 是一项技术要求很高的手术。本研究比较了机器人 (R) 和腹腔镜 (L) LLR 对位于后上肝段（IV、VII 和 VIII）肿瘤的结果。方法这是一项对 2010 年至 2019 年间在 24 个中心接受 R-LLR 或 L-LLR 的患者进行的国际多中心回顾性分析。分析了患者人口统计学、围手术期参数和术后结果；进行1:3倾向评分匹配(PSM)和1:1粗化精确匹配(CEM)。结果在 1566 名接受 R-LLR 和 L-LLR 治疗的患者中，983 名患者符合研究纳入标准。匹配前，包含 159 个 R-LLR 和 824 个 L-LLR。对 127 个 R-LLR 和 381 个 L-LLR 进行 1:3 PSM 后，围手术期结果的比较显示，中位失血量（100 (iqr 40–200) 与 200 (100–500) ml；P = 0.003）、失血量至少 500 毫升（9 例（7.4%）对比 94 例（27.6%）；P < 0.001），术中输血率（4 例（3.1%）对比 38 例（10.0%）；P = 0.025），转换为开放手术的比例（1（0.8%）与 30（7.9%）；P = 0.022），应用 Pringle 操作时的中位持续时间（30（20-46）与 40（25-58）分钟；P =与 L-LLR 组相比，R-LLR 组的中位手术时间（175 (130–255) vs 224 (155–300)；P < 0.001）较低。在 104 个 R-LLR 与 104 个 L-LLR 进行 1:1 CEM 后，R-LLR 类似地与显着减少的失血量和较低的转为开放手术的比率相关。结论根据对精心挑选的患者的匹配分析，机器人和腹腔镜手术都可以安全地进行，对后上肝段的肿瘤具有良好的效果。