To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy(L-MH).
Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether robotic major hepatectomy (R-MH) is superior to laparoscopic major hepatectomy (L-MH).
This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience/ volume, perioperative outcomes and tumor characteristics were collected and analyzed. 1:1 propensity score matched (PSM) and coarsened-exact matched (CEM) analysis was performed to minimize selection bias between both groups.
A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM, (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss (PSM:200.0 [IQR:100.0, 450.0] ml vs. 300.0 [IQR:150.0, 500.0] ml; P=0.012; CEM:170.0 [IQR: 90.0, 400.0] ml vs. 200.0 [IQR:100.0, 400.0] ml; P=0.006), lower rates of Pringle maneuver application (PSM: 47.1% vs. 63.0%; P<0.001; CEM: 54.0% vs 65.0%; P=0.007) and open conversion (PSM: 5.1% vs. 11.9%; P<0.001; CEM: 5.5% vs. 10.4%, P=0.04) compared to L-MH. On subset analysis of 1273 cirrhotic patients, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs. 29.9%; P=0.02; CEM 10.4% vs. 25.5%; P=0.02) and shorter postoperative stay (PSM: 6.9 [IQR: 5.0, 9.0] days vs. 8.0 [IQR: 6.0 11.3] days; P<0.001; CEM 7.0 [IQR: 5.0, 9.0] days vs. 7.0 [IQR: 6.0, 10.0] days; P=0.047).
This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application and conversion to open surgery.

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