Efficacy and safety of robotic-assisted <i>versus</i> laparoscopic hepatectomy for hepatic neoplasms: a meta-analysis _Chinese Journal of Evidence-Based Medicine

Authors：

HU Lidong ^1,2,3 , YAO Liang ³ , TIAN Hongwei ¹ , LI Xiaofei ^1,4 , JIN Penghui ^1,2 , LI Huimin ^1,4 ,  YANG Kehu ^3,5 ,  LIU Rong ⁶ ,  GUO Tiankang ^1,2,3,4

1. Department of General Surgery, People’s Hospital of Gansu Province, Lanzhou, 730000, P.R.China;
2. Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P.R.China;
3. Institution of Clinical Research and Evidence-Based Medicine, People’s Hospital of Gansu Province, Lanzhou, 730000, P.R.China;
4. School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750001, P.R.China;
5. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;
6. The Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, P.R.China;

Corresponding author：

LIU Rong, Email: liurong301@126.com; GUO Tiankang, Email: tiankangguo2016@163.com

Keywords：

Hepatic neoplasm; Robotic-assisted; Laparoscopic; Hepatectomy; Meta-analysis; Systematic review; Cohort study

DOI：

10.7507/1672-2531.201703141

Video：

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ObjectiveTo systematically review the efficacy and safety of robotic-assisted hepatectomy (RAH) versus traditional laparoscopic hepatectomy (TLH) for hepatic neoplasms.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and CBM databases were electronically searched to collect cohort studies about the RAH vs. the TLH for liver neoplasms from inception to December 10^th, 2016. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And finally, a meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 17 studies involving 1 389 patients were included. The meta-analysis results showed that: compared to TLH group, RAH group was associated with more estimated blood loss (WMD=39.56, 95%CI 4.65 to 74.47, P=0.013), longer operative time SMD=0.55, 95%CI 0.29 to 0.80, P<0.001), and later in the first nutritional intake time (SMD=1.06, 95%CI 0.66 to 1.45,P<0.001). However, there were no significant differences in the length of hospital stay, conversion to laparotomy, intraoperative blood transfusion, resection rate of tumor margin, complications and 90-day mortality between the two groups.ConclusionCurrent evidence indicates that TLH is superior to RAH in terms of operative time, intraoperative blood loss and the first nutritional intake time, but there are no statistically significant differences in the primary outcomes, suggesting that RAH and TLH have similar efficacy and safety for hepatic neoplasms. Due to the limitation of quality and quantity of the included studies, the above conclusions need to be verified by more high-quality research.

Citation： HU Lidong, YAO Liang, TIAN Hongwei, LI Xiaofei, JIN Penghui, LI Huimin, YANG Kehu, LIU Rong, GUO Tiankang. Efficacy and safety of robotic-assisted versus laparoscopic hepatectomy for hepatic neoplasms: a meta-analysis . Chinese Journal of Evidence-Based Medicine, 2018, 18(3): 334-341. doi: 10.7507/1672-2531.201703141 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Ocuin LM, Tsung A. Minimally invasive hepatic surgery. Surg Clin North Am, 2016, 96(2): 299-313.
3.	Quijano Y, Vicente E, Ielpo B, et al. Robotic liver surgery: early experience from a single surgical center. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 66-71.
4.	Pilgrim CH, To H, Usatoff V, et al. Laparoscopic hepatectomy is a safe procedure for cancer patients. HPB (Oxford), 2009, 11(3): 247-251.
5.	Sugimoto M, Tanaka K, Matsuoka Y, et al. da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access. J Hepatobiliary Pancreat Sci, 2011, 18(4): 493-498.
6.	Tomulescu V, Stănciulea O, Bălescu I, et al. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur), 2009, 104(2): 141-150.
7.	Velayutham V, Fuks D, Nomi T, et al. 3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study. Surg Endosc, 2016, 30(1): 147-153.
8.	Montalti R, Berardi G, Patriti A, et al. Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World J Gastroenterol, 2015, 21(27): 8441-8451.
9.	Qiu J, Chen S, Chengyou D. A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc, 2016, 30(3): 862-875.
10.	Lai EC, Tang CN. Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Tech, 2016, 26(2): 162-166.
11.	Lee KF, Cheung YS, Chong CC, et al. Laparoscopic and robotic hepatectomy: experience from a single centre. ANZ J Surg, 2016, 86(3): 122-126.
12.	Croner RS, Perrakis A, Hohenberger W, et al. Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg, 2016, 401(5): 707-714.
13.	Montalti R, Scuderi V, Patriti A, et al. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc, 2016, 30(3): 1004-1013.
14.	Kim JK, Park JS, Han DH, et al. Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc, 2016, 30(11): 4756-4764.
15.	Salloum C, Lahat E, Lin C, et al. Minimally invasive left lateral sectionectomy robot vs. laparoscopy. HPB (Oxford), 2016, 18: e234.
16.	中华人民共和国卫生部. 原发性肝癌诊疗规范. 临床肝胆病杂志, 2011, 20(11): 929-946.
17.	NCCN Guidelines Version 2. 2016 panel members hepatobiliary cancers. National comprehensive cancer network, 2016. Available at: www.crtog.org/UploadFiles/2016-12/95/3131268661724938.pdf.
18.	Verslype C, Rosmorduc O, Rougier P, et al. Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2012, 23(Suppl 7): v41-v48.
19.	Chow PK, Choo SP, Ng DC, et al. National cancer centre singapore consensus guidelines for hepatocellular carcinoma. Liver Cancer, 2016, 5(2): 97-106.
20.	Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean liver cancer study group-national cancer center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol, 2015, 16(3): 465-522.
21.	Spampinato MG, Coratti A, Bianco L, et al. Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc, 2014, 28(10): 2973-2979.
22.	Tranchart H, Ceribelli C, Ferretti S, et al. Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg, 2014, 38(11): 2904-2909.
23.	Tsung A, Geller DA, Sukato DC, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg, 2014, 259(3): 549-555.
24.	Yu YD, Kim KH, Jung DH, et al. Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg, 2014, 399(8): 1039-1045.
25.	Wu YM, Hu RH, Lai HS, et al. Robotic-assisted minimally invasive liver resection. Asian J Surg, 2014, 37(2): 53-57.
26.	Troisi RI, Patriti A, Montalti R, et al. Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot, 2013, 9(2): 160-166.
27.	Packiam V, Bartlett DL, Tohme S, et al. Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg, 2012, 16(12): 2233-2238.
28.	赵舒霖, 沈柏用, 邓侠兴, 等. 肝脏肿瘤的微创治疗-从腹腔镜到机器人. 中国普外基础与临床杂志, 2012, 19(7): 697-703.
29.	Ji WB, Wang HG, Zhao ZM, et al. Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg, 2011, 253(2): 342-348.
30.	樊嘉, 周俭, 王鲁, 等. 比较机器人外科手术系统与腹腔镜肝切除治疗肝细胞癌的初步结果. 上海医学, 2011, 34(1): 15-18.
31.	Berber E, Akyildiz HY, Aucejo F, et al. Robotic versus laparoscopic resection of liver tumours. HPB (Oxford), 2010, 12(8): 583-586.
32.	Ho CM, Wakabayashi G, Nitta H, et al. Total laparoscopic limited anatomical resection for centrally located hepatocellular carcinoma in cirrhotic liver. Surg Endosc, 2013, 27(5): 1820-1825.
33.	Ishizaki M, Kaibori M, Matsui K, et al. A novel technique of laparoscopic hepatectomy. Gan To Kagaku Ryoho, 2014, 41(12): 1494-1496.
34.	Qian NS, Liao YH, Cai SW, et al. Comprehensive application of modern technologies in precise liver resection. Hepatobiliary Pancreat Dis Int, 2013, 12(3): 244-250.
35.	Patriti A, Ceccarelli G, Bartoli A, et al. Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): e242-e244.
36.	Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol, 2015, 16(3): 465-522.
37.	Liu L, Wang Z, Jiang S, et al. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS One, 2013, 8(5): e64261.
38.	Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg, 2007, 245(1): 36-43.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Ocuin LM, Tsung A. Minimally invasive hepatic surgery. Surg Clin North Am, 2016, 96(2): 299-313.
3. Quijano Y, Vicente E, Ielpo B, et al. Robotic liver surgery: early experience from a single surgical center. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 66-71.
4. Pilgrim CH, To H, Usatoff V, et al. Laparoscopic hepatectomy is a safe procedure for cancer patients. HPB (Oxford), 2009, 11(3): 247-251.
5. Sugimoto M, Tanaka K, Matsuoka Y, et al. da Vinci robotic single-incision cholecystectomy and hepatectomy using single-channel GelPort access. J Hepatobiliary Pancreat Sci, 2011, 18(4): 493-498.
6. Tomulescu V, Stănciulea O, Bălescu I, et al. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur), 2009, 104(2): 141-150.
7. Velayutham V, Fuks D, Nomi T, et al. 3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study. Surg Endosc, 2016, 30(1): 147-153.
8. Montalti R, Berardi G, Patriti A, et al. Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World J Gastroenterol, 2015, 21(27): 8441-8451.
9. Qiu J, Chen S, Chengyou D. A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc, 2016, 30(3): 862-875.
10. Lai EC, Tang CN. Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Tech, 2016, 26(2): 162-166.
11. Lee KF, Cheung YS, Chong CC, et al. Laparoscopic and robotic hepatectomy: experience from a single centre. ANZ J Surg, 2016, 86(3): 122-126.
12. Croner RS, Perrakis A, Hohenberger W, et al. Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbecks Arch Surg, 2016, 401(5): 707-714.
13. Montalti R, Scuderi V, Patriti A, et al. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc, 2016, 30(3): 1004-1013.
14. Kim JK, Park JS, Han DH, et al. Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc, 2016, 30(11): 4756-4764.
15. Salloum C, Lahat E, Lin C, et al. Minimally invasive left lateral sectionectomy robot vs. laparoscopy. HPB (Oxford), 2016, 18: e234.
16. 中华人民共和国卫生部. 原发性肝癌诊疗规范. 临床肝胆病杂志, 2011, 20(11): 929-946.
17. NCCN Guidelines Version 2. 2016 panel members hepatobiliary cancers. National comprehensive cancer network, 2016. Available at: www.crtog.org/UploadFiles/2016-12/95/3131268661724938.pdf.
18. Verslype C, Rosmorduc O, Rougier P, et al. Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2012, 23(Suppl 7): v41-v48.
19. Chow PK, Choo SP, Ng DC, et al. National cancer centre singapore consensus guidelines for hepatocellular carcinoma. Liver Cancer, 2016, 5(2): 97-106.
20. Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean liver cancer study group-national cancer center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol, 2015, 16(3): 465-522.
21. Spampinato MG, Coratti A, Bianco L, et al. Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc, 2014, 28(10): 2973-2979.
22. Tranchart H, Ceribelli C, Ferretti S, et al. Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg, 2014, 38(11): 2904-2909.
23. Tsung A, Geller DA, Sukato DC, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg, 2014, 259(3): 549-555.
24. Yu YD, Kim KH, Jung DH, et al. Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg, 2014, 399(8): 1039-1045.
25. Wu YM, Hu RH, Lai HS, et al. Robotic-assisted minimally invasive liver resection. Asian J Surg, 2014, 37(2): 53-57.
26. Troisi RI, Patriti A, Montalti R, et al. Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot, 2013, 9(2): 160-166.
27. Packiam V, Bartlett DL, Tohme S, et al. Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg, 2012, 16(12): 2233-2238.
28. 赵舒霖, 沈柏用, 邓侠兴, 等. 肝脏肿瘤的微创治疗-从腹腔镜到机器人. 中国普外基础与临床杂志, 2012, 19(7): 697-703.
29. Ji WB, Wang HG, Zhao ZM, et al. Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg, 2011, 253(2): 342-348.
30. 樊嘉, 周俭, 王鲁, 等. 比较机器人外科手术系统与腹腔镜肝切除治疗肝细胞癌的初步结果. 上海医学, 2011, 34(1): 15-18.
31. Berber E, Akyildiz HY, Aucejo F, et al. Robotic versus laparoscopic resection of liver tumours. HPB (Oxford), 2010, 12(8): 583-586.
32. Ho CM, Wakabayashi G, Nitta H, et al. Total laparoscopic limited anatomical resection for centrally located hepatocellular carcinoma in cirrhotic liver. Surg Endosc, 2013, 27(5): 1820-1825.
33. Ishizaki M, Kaibori M, Matsui K, et al. A novel technique of laparoscopic hepatectomy. Gan To Kagaku Ryoho, 2014, 41(12): 1494-1496.
34. Qian NS, Liao YH, Cai SW, et al. Comprehensive application of modern technologies in precise liver resection. Hepatobiliary Pancreat Dis Int, 2013, 12(3): 244-250.
35. Patriti A, Ceccarelli G, Bartoli A, et al. Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): e242-e244.
36. Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol, 2015, 16(3): 465-522.
37. Liu L, Wang Z, Jiang S, et al. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS One, 2013, 8(5): e64261.
38. Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg, 2007, 245(1): 36-43.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of robotic-assisted versus laparoscopic hepatectomy for hepatic neoplasms: a meta-analysis

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