Minimally-Invasive Liver Surgery Results in Better Perioperative Outcomes Compared to a Traditional Open Surgical Approach Michael
1Donald
1 McDonagh and
Gary
1,2 Deutsch
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Northwell Health Cancer Institute, Lake Success, NY, USA
Background
Results
• The prevalence of these robotic-assisted procedures is increasing, however there has still been resistance to wide acceptance • Relative lack of research into how patient outcomes in robotic-assisted procedures compare to open abdominal surgeries • This research will compare our institution’s surgical outcomes in robotic-assisted partial hepatectomies (RAPHs) vs. open abdominal partial hepatectomies (OAPHs), including:
Statistical analysis was then performed on this subset of open (n = 63) and robotic (n = 42) patients.
• length of procedure • length of hospital stay • post-procedural pain medication requirements
(2) Decrease in the post-operative complication and 30-day readmission rate in RAPHs
Figure 1: Demographic breakdown of patients based on age, sex, BMI, and ASA in the RAPH and OAPH groups. Significance determined by p < 0.05.
• A statistically relevant decrease in length of IV analgesia use is still exists when controlling for length of stay. • The results do not suggest a difference in oncologic survival. • Our data demonstrated a numerical but not statistically significant difference in 30-day readmission rates (open, n = 10; robotic, n = 3).
Future Direction Figure 2: Outcomes vs. type of partial hepatectomy performed. Post-operative length of IV analgesia use vs. type of partial hepatectomy performed with length of stay controlled. Significance determined by p < 0.05.
Methods • Retrospective review • 138 patients who underwent either RAPH or OAPH between 02/2015 and 07/2020 • Exclusion criteria à insufficient historical data, data >3 SD from mean, >2 procedures performed during the operation. • Pearson chi-squared and Student’s T test was used to assess continuous and categorical data. Univariate and multivariate analysis to assess potential factors associated with length of stay and length of IV analgesia use.
• Our results suggest that RAPH can be considered as a viable option for patients with primary and secondary hepatic malignancies. • The data suggests that there is a statistically relevant decrease in post-operative length of stay and length of IV analgesia use.
Hypothesis (1) Decrease in the length of perioperative procedure time, length of post-operative hospital stay, and length of post-operative IV analgesia use in RAPHs
Conclusions
• Further analysis should attempt to address which specific patient populations would benefit most from receiving RAPH when compared to OAPH. • While short-term outcomes are important, we should continue to follow these patients to be able to report more long-term survival and recurrence rates. • Finally, while the rate of complications did not differ between the two groups, further analyses are needed to determine whether the severity of complications is statistically significant between groups.
Resources 1Koti
Figure 3: Kaplan-Meyer Survival Curve Comparing OAPH and RAPH survival.
S, Conte C, Kadison AB, et al. Enhanced postoperative recovery with minimally invasive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies of gastrointestinal origin. Surg Oncol. 2020; 33: 38-42. 2Barakat EE, Bedaiwy MA., Zimberg S, et al. Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy: A Comparison of Surgical Outcomes. Obstet Gynecol. 2011; 111(2): 256-266. 3Park JS, Choi G, Lim KH, et al. Robotic-Assisted versus Laparoscopic Surgery for Low Rectal Cancer: Case-Matched Analysis of Short-Term Outcomes. Ann Surg Oncol. 2010; 17: 3195-3202