Outcomes of robotic-assisted liver surgery versus laparoscopic liver surgery for treatment of stage I hepatocellular carcinoma.
Outcomes of robotic-assisted liver surgery versus laparoscopic liver surgery for treatment of stage I hepatocellular carcinoma.
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DOI：
10.1002/cncr.33979
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发表时间：
2022-02-15
期刊：
影响因子：
6.2
通讯作者：
Shu, Xiao-Ou
中科院分区：
文献类型：
--
作者：
Duong, Linh M.;Cai, Hui;Shrubsole, Martha J.;Bailey, Christina E.;Idrees, Kamran;Shu, Xiao-Ou
我们调查了机器人辅助肝手术和腹腔镜肝手术治疗肝细胞癌的短期和长期临床结果是否相似或不同。我们从国家癌症数据库中确定了2010-2015年间总共接受微创手术(即机器人或腹腔镜手术)治疗I期肝癌的3049名患者，其中123名接受了机器人手术，2926名接受了腹腔镜手术。采用Logistic回归分析评价近期疗效。应用COX比例风险模型估计术后1年、3年和5年的全因死亡率，调整潜在的混杂因素。进行倾向性评分匹配分析，比较机器人手术和腹腔镜手术的长期结果。我们发现，机器人手术与提高总体存活率有关，1、3和5年存活率(SRS)分别为0.92、0.75和0.63，而腹腔镜术的SRS分别为0.86、0.60和0.45。多因素分析显示，与腹腔镜手术相比，机器人手术的5年总死亡率显著降低(意向治疗分析的HR=0.64，95%CI：0.45-0.93；终末治疗分析的HR=0.62，95%CI：0.42-0.91)。在倾向评分匹配分析中也发现了类似的结果；与腹腔镜手术相比，机器人手术与总存活率的提高有关(对于打算治疗的机器人手术，HR=0.64，95%CI：0.43~0.96；对于终末治疗，HR=0.59，95%CI：0.39~0.90)。机器人手术在治疗早期肝癌方面并不逊色于腹腔镜手术，并且可能与改善长期存活率有关。在这项迄今为止规模最大的研究中，我们发现机器人手术在治疗早期肝细胞癌方面并不逊色于腹腔镜手术。事实上，接受机器人手术的患者比接受腹腔镜手术的患者有更高的5年总存活率。
We investigated whether robotic-assisted liver surgery versus laparoscopic liver surgical treatment of hepatocellular carcinoma (HCC) has similar or different short- and long-term clinical outcomes. We identified a total of 3,049 patients from the National Cancer Database who received minimally invasive surgery (i.e., robotic or laparoscopic surgery) for stage I HCC cancers between 2010–2015, of which 123 had robotic and 2,926 had laparoscopic surgeries performed. Logistic regression was applied to evaluate short-term outcomes. Cox proportional hazards models were applied to estimate all-cause mortality at 1-year, 3-years, and 5-years after surgery, adjusting for potential confounders. Propensity score matched analyses were conducted to compare long-term outcomes between robotic and laparoscopic surgeries. We found that robotic surgery was associated with improved overall survival, with 1-, 3- and 5-year survival rates (SRs) of 0.92, 0.75 and 0.63 compared with laparoscopic surgery SRs of 0.86, 0.60 and 0.45, respectively; p-value < 0.01. Multivariate analyses showed that robotic compared with laparoscopic surgery had significantly lower 5-year total mortality (HR = 0.64, 95% CI: 0.45–0.93 for intent-to-treat, and HR = 0.62, 95% CI: 0.42–0.91 for end-treatment analyses). Similar results were found in propensity score matched analyses; robotic surgery was associated with improved overall survival compared with laparoscopic surgery (HR = 0.64, 95% CI: 0.43–0.96 for intent-to-treat, and HR = 0.59, 95% CI: 0.39–0.90 for end-treatment). Robotic surgery is not inferior to laparoscopic surgery in treating early-stage HCC and may be associated with improved long-term survival. In this largest study to date, we found that robotic surgery is not inferior to laparoscopic surgery in treating early-stage hepatocellular carcinoma. In fact, patients treated with robotic surgery had a higher 5-year overall survival rate compared with those treated with laparoscopic surgery.
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影响因子：
3.7
作者：
Zhang L;Yuan Q;Xu Y;Wang W
通讯作者：
Wang W
影响因子：
81.5
作者：
Llovet, Josep M.;Zucman-Rossi, Jessica;Gores, Gregory
通讯作者：
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影响因子：
3.7
作者：
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影响因子：
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作者：
Wu, Lu;Tsilimigras, Diamantis, I;Pawlik, Timothy M.
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Pawlik, Timothy M.
DOI：
10.1016/j.bpg.2014.08.007
发表时间：
2014-10-01
影响因子：
3.2
作者：
Bosetti, Cristina;Turati, Federica;La Vecchia, Carlo
通讯作者：
La Vecchia, Carlo