Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis

The implementation of the laparoscopic and robotic approaches for major hepatectomy (LMH and RMH) was slower than that for minor hepatectomy, but has significantly increased over the past years. The role or advantages of RMH remains controversial, and we aimed to compare the peri-/postoperative outcomes of LMH versus RMH.

A systematic literature review was conducted using the MEDLINE and Cochrane Library databases according to the PRISMA guidelines (end-of-search date: March 16th, 2020). Only comparative studies (LMH vs. RMH) reporting on outcomes of interest were included. Meta-analysis was performed using the random-effects model when substantial heterogeneity was encountered; otherwise, the fixed-effects model was implemented. Quality of evidence assessment was performed using the Newcastle-Ottawa Scale.

Seven retrospective cohort studies comparing LMH (n = 300) versus RMH (n = 225) were identified. No significant difference was observed between LMH and RMH regarding overall complications [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.90-2.23; p = 0.13], severe complications (Clavien-Dindo grade ≥ 3) [risk difference (RD) 0.01, 95% CI - 0.03 to 0.05; p = 0.72], and overall mortality (RD 0.00, 95% CI - 0.02 to 0.03; p = 0.73). The two approaches were also equivalent regarding conversion to open hepatectomy (RD 0.03, 95% CI - 0.01 to 0.08; p = 0.15), margin-positive resection (OR 1.34, 95% CI 0.51-3.52; p = 0.55), and transfusion rate (RD - 0.03, 95% CI - 0.16 to 0.11; p = 0.67). No significant difference was observed for LMH versus RMH regarding blood loss [standardized mean difference (SMD) 0.27, 95% CI - 0.24 to 0.77; p = 0.30), operative time (SMD - 0.08, 95% CI - 0.51 to 0.34; p = 0.70), and length of stay (SMD 0.13, 95% CI - 0.58 to 0.84; p = 0.72).

LMH and RMH have equivalent peri-/postoperative outcomes when performed in select patients and high-volume centers.