Robotic and open resection for perihilar cholangiocarcinoma: comparative PSB-based analysis of short-term outcomes and survival (single-center experience)
EAES Academy. Elizarova N. 07/05/22; 366522; P239
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Abstract
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The aim of the study was to compare short term outcomes and survival after robotic and open liver and bile ducts resection for perihilar cholangiocarcinoma (PHCC).
Methods. Since October 2013, more than 140 patients with PHCC have undergone radical surgery at the Loginov Moscow Clinical Research Center. Since March 2014, the use of robotic access has begun (16 patients in total). Propensity score matching (PSM) was used for comparative analysis of single-center open and robotic resection outcomes. The balance of covariates was evaluated using standardized mean differences. Using COX regression analysis, we determined predictors for survival and compared groups of robotic and open resection according to them.
Results. There were no differences in short-term outcomes, including morbidity and 90-day mortality, between the groups of robotic and open resection. After PSM, 4-year overall survival was 50% and 63% (P-=0,428), and recurrence-free survival was 45% and 52% (P=0,511) in the robotic and open groups, respectively. No significant difference was found between values of short-term oncological outcomes in terms of number of lymph nodes harvested and the rate of R0 resection with tendency to more frequent R0 resection in robotic group before and after PSM. Immediate surgical outcomes, including morbidity, type of complications, mortality and length of hospital stay were comparable in two groups. There was no differences in the overall and recurrence-free survival between two groups.
Conclusion: Robotic approach is not inferior to standard open resection in terms of immediate outcomes. The minimally invasive technology in PHCC treatment are not yet established sufficiently to exclude the influence of learning curve on survival after surgery. In the current study, survival after robotic resection was not inferior in comparison to open resection; nevertheless, the selection biases could not be excluded despite the propensity score matching. The selection criteria for minimally invasive surgery for PHCC remain unclear.
Methods. Since October 2013, more than 140 patients with PHCC have undergone radical surgery at the Loginov Moscow Clinical Research Center. Since March 2014, the use of robotic access has begun (16 patients in total). Propensity score matching (PSM) was used for comparative analysis of single-center open and robotic resection outcomes. The balance of covariates was evaluated using standardized mean differences. Using COX regression analysis, we determined predictors for survival and compared groups of robotic and open resection according to them.
Results. There were no differences in short-term outcomes, including morbidity and 90-day mortality, between the groups of robotic and open resection. After PSM, 4-year overall survival was 50% and 63% (P-=0,428), and recurrence-free survival was 45% and 52% (P=0,511) in the robotic and open groups, respectively. No significant difference was found between values of short-term oncological outcomes in terms of number of lymph nodes harvested and the rate of R0 resection with tendency to more frequent R0 resection in robotic group before and after PSM. Immediate surgical outcomes, including morbidity, type of complications, mortality and length of hospital stay were comparable in two groups. There was no differences in the overall and recurrence-free survival between two groups.
Conclusion: Robotic approach is not inferior to standard open resection in terms of immediate outcomes. The minimally invasive technology in PHCC treatment are not yet established sufficiently to exclude the influence of learning curve on survival after surgery. In the current study, survival after robotic resection was not inferior in comparison to open resection; nevertheless, the selection biases could not be excluded despite the propensity score matching. The selection criteria for minimally invasive surgery for PHCC remain unclear.
The aim of the study was to compare short term outcomes and survival after robotic and open liver and bile ducts resection for perihilar cholangiocarcinoma (PHCC).
Methods. Since October 2013, more than 140 patients with PHCC have undergone radical surgery at the Loginov Moscow Clinical Research Center. Since March 2014, the use of robotic access has begun (16 patients in total). Propensity score matching (PSM) was used for comparative analysis of single-center open and robotic resection outcomes. The balance of covariates was evaluated using standardized mean differences. Using COX regression analysis, we determined predictors for survival and compared groups of robotic and open resection according to them.
Results. There were no differences in short-term outcomes, including morbidity and 90-day mortality, between the groups of robotic and open resection. After PSM, 4-year overall survival was 50% and 63% (P-=0,428), and recurrence-free survival was 45% and 52% (P=0,511) in the robotic and open groups, respectively. No significant difference was found between values of short-term oncological outcomes in terms of number of lymph nodes harvested and the rate of R0 resection with tendency to more frequent R0 resection in robotic group before and after PSM. Immediate surgical outcomes, including morbidity, type of complications, mortality and length of hospital stay were comparable in two groups. There was no differences in the overall and recurrence-free survival between two groups.
Conclusion: Robotic approach is not inferior to standard open resection in terms of immediate outcomes. The minimally invasive technology in PHCC treatment are not yet established sufficiently to exclude the influence of learning curve on survival after surgery. In the current study, survival after robotic resection was not inferior in comparison to open resection; nevertheless, the selection biases could not be excluded despite the propensity score matching. The selection criteria for minimally invasive surgery for PHCC remain unclear.
Methods. Since October 2013, more than 140 patients with PHCC have undergone radical surgery at the Loginov Moscow Clinical Research Center. Since March 2014, the use of robotic access has begun (16 patients in total). Propensity score matching (PSM) was used for comparative analysis of single-center open and robotic resection outcomes. The balance of covariates was evaluated using standardized mean differences. Using COX regression analysis, we determined predictors for survival and compared groups of robotic and open resection according to them.
Results. There were no differences in short-term outcomes, including morbidity and 90-day mortality, between the groups of robotic and open resection. After PSM, 4-year overall survival was 50% and 63% (P-=0,428), and recurrence-free survival was 45% and 52% (P=0,511) in the robotic and open groups, respectively. No significant difference was found between values of short-term oncological outcomes in terms of number of lymph nodes harvested and the rate of R0 resection with tendency to more frequent R0 resection in robotic group before and after PSM. Immediate surgical outcomes, including morbidity, type of complications, mortality and length of hospital stay were comparable in two groups. There was no differences in the overall and recurrence-free survival between two groups.
Conclusion: Robotic approach is not inferior to standard open resection in terms of immediate outcomes. The minimally invasive technology in PHCC treatment are not yet established sufficiently to exclude the influence of learning curve on survival after surgery. In the current study, survival after robotic resection was not inferior in comparison to open resection; nevertheless, the selection biases could not be excluded despite the propensity score matching. The selection criteria for minimally invasive surgery for PHCC remain unclear.
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