Multicenter Propensity Score-Matched Analysis to Compare Perioperative Morbidity After Laparoscopic or RoboticComplex Hepatectomy for Solitary Hepatocellular Carcinoma

Abstract

Abstract Background & Aims Postoperative complications are vital factors affecting the prognosis of patients with hepatocellular carcinoma (HCC), especially for complex hepatectomy. The present study aimed to compare perioperative complications between laparoscopic and robotic complex hepatectomy (LCH vs. RCH). MethodsPatients with solitary HCC after complex hepatectomy were collected from a multicenter database. Intraoperative variables and postoperative morbidity were compared to assess perioperative risk. Propensity score-matched (PSM) analysis was adopted to overcome selection bias. Multivariable logistic regression was performed to determine the independent risk factors. Results 436 patients were included eventually. Among them, 385 patients received LCH, and 51 patients received RCH. After PSM, the results showed that compared to LCH, RCH had lower rates of intraoperative blood loss and transfusion, as well as lower postoperative 30-day, major mortality, and post-hepatectomy liver failure (PHLF) (all P < 0.05). Additionally, the length of hospital stay was shorter in the RCH group (P = 0.026). Multivariable analysis showed RCH is an independent protective factor for reducing the 30-day mortality (OR 0.657, 95%CI 0.361-0.983, P = 0.046), major mortality (OR 0.709, 95%CI 0.512-0.899, P = 0.043) and PHLF (OR 0.765, 95%CI 0.221-0.978, P = 0.044). Conclusion RCH has advantages over LCH in the minimally invasive treatment of complex HCC, as it can reduce the incidence of intraoperative blood loss and postoperative mortality, especially for major mortality and PHLF. Therefore, robotic surgery should be considered for patients with HCC who require complex hepatectomy.