Textbook outcomes for robotic liver resection: assessing relevant clinical variables

Textbook outcome (TO) is a multidimensional metric for assessing surgical success, integrating several postoperative variables into a single composite endpoint. While TO definitions have been validated for open and laparoscopic liver resections (LR), no consensus exist for the robotic approach. This retrospective study assesses TO and extended-TO (TOLS+) in patients undergoing robotic LR, and explores perioperative factors associated with TO-achievement.

We analyzed 622 consecutive robotic LR for benign and malignant disease between 2013 and 2024. TO and TOLS+ were defined according to a global expert Delphi consensus in 2023. Logistic regression analyses were conducted to identify TO-achievement predictors.

Among 546 patients, 488 (89.4%) achieved TO and 358 (65.6%) met TOLS + criteria. Non-TO patients exhibited longer operative times (315.2 ± 147.4 vs. 267.3 ± 121.5 min, p = 0.0141), higher estimated blood loss (254.9 ± 300.7 vs. 165.3 ± 186.7 mL, p = 0.0193), higher rates of unplanned conversion (5.2% vs. 0.4%, p = 0.0098), and ICU admission (29.8% vs. 2.9%, p < 0.0001). TO was significantly associated with history of myocardial infarction, ICU admission, and prolonged LOS.

Robotic LR achieved high TO and TOLS + rates within our cohort. These findings underscore the role of robotic platforms in promoting optimal surgical outcomes in high-volume centers.