Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments: An International Multicenter Study

Felix Krenzien, Moritz Schmelzle, Johann Pratschke, Linda Feldbrügge, Rong Liu, Qu Liu, Wanguang Zhang, Joseph J. Zhao, Hwee Leong Tan, Federica Cipriani, Tijs J. Hoogteijling, Davit L. Aghayan, Åsmund A. Fretland, Tiing Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio F. Coelho, Marco V. Marino, Vincenzo MazzaferroAdrian K.H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Gastaca, 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, Kiyoshi Hasegawa, 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 M. Ettorre, Franco Pascual, Daniel Cherqui, Junhao Zheng, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I. Troisi, Tan To Cheung, Yutaro Kato, Atsushi Sugioka, Safi Dokmak, Mizelle D'Silva, Ho Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Mohammad Abu Hilal, Kuo Hsin Chen, David Fuks, Luca Aldrighetti, Bjørn Edwin, Brian K.P. Goh

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Objective: The purpose of this study was to compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments. Background: Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in the existing literature. Methods: This is a post hoc analysis of a multicenter database of 5446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII, and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumor features, and perioperative characteristics were collected and analyzed. Propensity score-matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias. Results: A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%), and 461 underwent RLLR (13%). After PSM (1:1: And 1:2), RLLR was associated with a lower open conversion rate [10 of 449 (2.2%) vs 54 of 898 (6.0%); P=0.002], less blood loss [100 mL [IQR: 50-200) days vs 150 mL (IQR: 50-350); P<0.001] and a shorter operative time (188 min (IQR: 140-270) vs 222 min (IQR: 158-300); P<0.001]. These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis-lower open conversion rate [1 of 136 (0.7%) vs 17 of 272 (6.2%); P=0.009], less blood loss [100 mL (IQR: 48-200) vs 160 mL (IQR: 50-400); P<0.001], and shorter operative time [190 min (IQR: 141-258) vs 230 min (IQR: 160-312); P=0.003]. Postoperative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset. Conclusions: RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss, and open conversion rate when compared with LLLR.

Original languageEnglish
Pages (from-to)297-305
Number of pages9
JournalAnnals of Surgery
Issue number2
Publication statusPublished - 01-02-2024

All Science Journal Classification (ASJC) codes

  • Surgery


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