{"title":"机器人和腹腔镜肝切除术在一个Couinaud节段内的比较：基于倾向评分的分析。","authors":"Awang Danzeng, Baima Deji, Zhen-Hua Yang, Xue-Wei Jiang, Ling Guo, Xin Luo, Bi-Xiang Zhang, Bin-Hao Zhang","doi":"10.1002/wjs.70121","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver resection (MILR), including laparoscopic (LLR) and robot-assisted (RLR) approaches, is being increasingly utilized for hepatic tumors, though comparative evidence for hepatectomy within one liver segment remains limited.</p><p><strong>Methods: </strong>From January 2015 to December 2024, 2290 patients underwent MILR for hepatic tumors at our institution. After excluding combined resections (other than cholecystectomy), resections involving more than one Couinaud segment, multiple tumors in different segments, and incomplete data, 718 single-segment cases (LLR, n = 630; RLR, n = 88) were analyzed. Propensity score matching (PSM) at 1:1 and 1:3 ratios was performed to balance baseline covariates.</p><p><strong>Results: </strong>Before matching, RLR had longer operative time (226.5 vs. 197.0 min; p = 0.027) and greater blood loss (150 vs. 100 mL; p = 0.037) than LLR, but less frequent Pringle maneuver use (53.4% vs. 64.8%; p = 0.038). After 1:1 and 1:3 propensity score matching, operative time, blood loss, conversion, transfusion, and R0 resection were comparable, whereas Pringle use remained lower with RLR (51.2% vs. 66.7%, p = 0.041; 51.2% vs. 64.3%, p = 0.035). Postoperatively, length of stay was longer after RLR in the unmatched cohort (8.0 vs. 7.0 days; p = 0.006), but not after matching (both 7.0 days). Major complications, including post-hepatectomy liver failure, hemorrhage, and bile leakage, were similar; no perioperative deaths occurred. Subgroup analyses showed shorter length of stay with RLR in advanced IWATE cases (RR, 0.79; 95% CI, 0.64-0.97; p = 0.022) and caudate resections (RR, 0.65; 95% CI, 0.46-0.90; p = 0.010), and shorter operative time in advanced IWATE cases (RR, 0.85; 95% CI, 0.74-0.99; p = 0.039), with significant interaction across IWATE levels (p = 0.047).</p><p><strong>Conclusions: </strong>RLR and LLR yielded comparable perioperative outcomes in single-segment liver resections. Nonetheless, RLR was associated with reduced reliance on vascular inflow occlusion and conferred selective advantages in anatomically complex or high-difficulty cases.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of Robotic and Laparoscopic Liver Resection Within One Couinaud Segment: A Propensity Score-Based Analysis.\",\"authors\":\"Awang Danzeng, Baima Deji, Zhen-Hua Yang, Xue-Wei Jiang, Ling Guo, Xin Luo, Bi-Xiang Zhang, Bin-Hao Zhang\",\"doi\":\"10.1002/wjs.70121\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Minimally invasive liver resection (MILR), including laparoscopic (LLR) and robot-assisted (RLR) approaches, is being increasingly utilized for hepatic tumors, though comparative evidence for hepatectomy within one liver segment remains limited.</p><p><strong>Methods: </strong>From January 2015 to December 2024, 2290 patients underwent MILR for hepatic tumors at our institution. After excluding combined resections (other than cholecystectomy), resections involving more than one Couinaud segment, multiple tumors in different segments, and incomplete data, 718 single-segment cases (LLR, n = 630; RLR, n = 88) were analyzed. Propensity score matching (PSM) at 1:1 and 1:3 ratios was performed to balance baseline covariates.</p><p><strong>Results: </strong>Before matching, RLR had longer operative time (226.5 vs. 197.0 min; p = 0.027) and greater blood loss (150 vs. 100 mL; p = 0.037) than LLR, but less frequent Pringle maneuver use (53.4% vs. 64.8%; p = 0.038). After 1:1 and 1:3 propensity score matching, operative time, blood loss, conversion, transfusion, and R0 resection were comparable, whereas Pringle use remained lower with RLR (51.2% vs. 66.7%, p = 0.041; 51.2% vs. 64.3%, p = 0.035). Postoperatively, length of stay was longer after RLR in the unmatched cohort (8.0 vs. 7.0 days; p = 0.006), but not after matching (both 7.0 days). Major complications, including post-hepatectomy liver failure, hemorrhage, and bile leakage, were similar; no perioperative deaths occurred. Subgroup analyses showed shorter length of stay with RLR in advanced IWATE cases (RR, 0.79; 95% CI, 0.64-0.97; p = 0.022) and caudate resections (RR, 0.65; 95% CI, 0.46-0.90; p = 0.010), and shorter operative time in advanced IWATE cases (RR, 0.85; 95% CI, 0.74-0.99; p = 0.039), with significant interaction across IWATE levels (p = 0.047).</p><p><strong>Conclusions: </strong>RLR and LLR yielded comparable perioperative outcomes in single-segment liver resections. Nonetheless, RLR was associated with reduced reliance on vascular inflow occlusion and conferred selective advantages in anatomically complex or high-difficulty cases.</p>\",\"PeriodicalId\":23926,\"journal\":{\"name\":\"World Journal of Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/wjs.70121\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/wjs.70121","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景：微创肝切除术（MILR），包括腹腔镜（LLR）和机器人辅助（RLR）方法，越来越多地用于肝脏肿瘤，尽管单肝段肝切除术的比较证据仍然有限。方法：2015年1月至2024年12月，我院2290例肝脏肿瘤患者行MILR治疗。在排除联合切除（除胆囊切除外）、多个Couinaud节段切除、不同节段多发肿瘤及资料不完整后，我们分析了718例单节段病例（LLR, n = 630； RLR, n = 88）。以1:1和1:3的比例进行倾向评分匹配（PSM）以平衡基线协变量。结果：配对前，RLR比LLR手术时间更长（226.5 vs. 197.0 min, p = 0.027），出血量更多（150 vs. 100 mL, p = 0.037），但Pringle手法使用频率较LLR低（53.4% vs. 64.8%, p = 0.038）。在1:1和1:3倾向评分匹配后，手术时间、出血量、转化、输血和R0切除具有可比性，而Pringle的使用仍然低于RLR（51.2%比66.7%,p = 0.041； 51.2%比64.3%,p = 0.035）。术后，在未匹配的队列中，RLR后的住院时间更长（8.0天和7.0天；p = 0.006），但匹配后的住院时间更长（均为7.0天）。主要并发症，包括肝切除术后肝功能衰竭、出血和胆漏，相似；无围手术期死亡发生。亚组分析显示，晚期IWATE患者的RLR治疗时间较短（RR, 0.79; 95% CI, 0.64-0.97; p = 0.022），尾状切除患者的RLR治疗时间较短（RR, 0.65; 95% CI, 0.46-0.90; p = 0.010），晚期IWATE患者的手术时间较短（RR, 0.85; 95% CI, 0.74-0.99; p = 0.039）， IWATE水平之间存在显著的相互作用（p = 0.047）。结论：在单节段肝切除术中，RLR和LLR的围手术期预后相当。尽管如此，RLR与减少对血管流入阻塞的依赖有关，并在解剖复杂或高难度的病例中具有选择性优势。
Comparison of Robotic and Laparoscopic Liver Resection Within One Couinaud Segment: A Propensity Score-Based Analysis.
Background: Minimally invasive liver resection (MILR), including laparoscopic (LLR) and robot-assisted (RLR) approaches, is being increasingly utilized for hepatic tumors, though comparative evidence for hepatectomy within one liver segment remains limited.
Methods: From January 2015 to December 2024, 2290 patients underwent MILR for hepatic tumors at our institution. After excluding combined resections (other than cholecystectomy), resections involving more than one Couinaud segment, multiple tumors in different segments, and incomplete data, 718 single-segment cases (LLR, n = 630; RLR, n = 88) were analyzed. Propensity score matching (PSM) at 1:1 and 1:3 ratios was performed to balance baseline covariates.
Results: Before matching, RLR had longer operative time (226.5 vs. 197.0 min; p = 0.027) and greater blood loss (150 vs. 100 mL; p = 0.037) than LLR, but less frequent Pringle maneuver use (53.4% vs. 64.8%; p = 0.038). After 1:1 and 1:3 propensity score matching, operative time, blood loss, conversion, transfusion, and R0 resection were comparable, whereas Pringle use remained lower with RLR (51.2% vs. 66.7%, p = 0.041; 51.2% vs. 64.3%, p = 0.035). Postoperatively, length of stay was longer after RLR in the unmatched cohort (8.0 vs. 7.0 days; p = 0.006), but not after matching (both 7.0 days). Major complications, including post-hepatectomy liver failure, hemorrhage, and bile leakage, were similar; no perioperative deaths occurred. Subgroup analyses showed shorter length of stay with RLR in advanced IWATE cases (RR, 0.79; 95% CI, 0.64-0.97; p = 0.022) and caudate resections (RR, 0.65; 95% CI, 0.46-0.90; p = 0.010), and shorter operative time in advanced IWATE cases (RR, 0.85; 95% CI, 0.74-0.99; p = 0.039), with significant interaction across IWATE levels (p = 0.047).
Conclusions: RLR and LLR yielded comparable perioperative outcomes in single-segment liver resections. Nonetheless, RLR was associated with reduced reliance on vascular inflow occlusion and conferred selective advantages in anatomically complex or high-difficulty cases.
期刊介绍：
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
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