Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis
Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and la...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/14/3360 |
| _version_ | 1797440394487660544 |
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| author | Mirhasan Rahimli Aristotelis Perrakis Mihailo Andric Jessica Stockheim Mareike Franz Joerg Arend Sara Al-Madhi Mohammed Abu Hilal Andrew A. Gumbs Roland S. Croner |
| author_facet | Mirhasan Rahimli Aristotelis Perrakis Mihailo Andric Jessica Stockheim Mareike Franz Joerg Arend Sara Al-Madhi Mohammed Abu Hilal Andrew A. Gumbs Roland S. Croner |
| author_sort | Mirhasan Rahimli |
| collection | DOAJ |
| description | Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42–1.18); <i>p</i> = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93–10.91); <i>p</i> = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66–52.57); <i>p</i> = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery. |
| first_indexed | 2024-03-09T12:07:32Z |
| format | Article |
| id | doaj.art-4c1ced9a662946edabc9cbcbc13cfcff |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T12:07:32Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-4c1ced9a662946edabc9cbcbc13cfcff2023-11-30T22:56:01ZengMDPI AGCancers2072-66942022-07-011414336010.3390/cancers14143360Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-AnalysisMirhasan Rahimli0Aristotelis Perrakis1Mihailo Andric2Jessica Stockheim3Mareike Franz4Joerg Arend5Sara Al-Madhi6Mohammed Abu Hilal7Andrew A. Gumbs8Roland S. Croner9Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyUnità Chirurgia Epatobiliopancreatica, Robotica e Mininvasiva, Fondazione Poliambulanza Istituto Ospedaliero, Via Bissolati, 57, 25124 Brescia, ItalyDepartment of Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300 Poissy, FranceDepartment of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, GermanyBackground: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases. Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity. Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42–1.18); <i>p</i> = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93–10.91); <i>p</i> = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66–52.57); <i>p</i> = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate. Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery.https://www.mdpi.com/2072-6694/14/14/3360liver surgeryrobotic surgerylaparoscopic surgeryhepatectomyresection marginmeta-analysis |
| spellingShingle | Mirhasan Rahimli Aristotelis Perrakis Mihailo Andric Jessica Stockheim Mareike Franz Joerg Arend Sara Al-Madhi Mohammed Abu Hilal Andrew A. Gumbs Roland S. Croner Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis Cancers liver surgery robotic surgery laparoscopic surgery hepatectomy resection margin meta-analysis |
| title | Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis |
| title_full | Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis |
| title_fullStr | Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis |
| title_short | Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery?—A Systematic Review and Meta-Analysis |
| title_sort | does robotic liver surgery enhance r0 results in liver malignancies during minimally invasive liver surgery a systematic review and meta analysis |
| topic | liver surgery robotic surgery laparoscopic surgery hepatectomy resection margin meta-analysis |
| url | https://www.mdpi.com/2072-6694/14/14/3360 |
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