Improving Patient Centered Outcomes with Robotic Hepatic Resection for Liver Tumors in a Tertiary Academic Transplant Center
*Sarah Meade, *Yee Lee Cheah, *Caroline J Simon, Roger L Jenkins, *Mohamed E Akoad
Lahey Clinic, Burlington, MA
1. Objective- Robotic techniques can improve patient centered metrics in hepatic resection.
2. Design- Retrospective cohort study comparing open versus robotic hepatic resection.
3. Setting- Tertiary care academic transplant center.
4. Patients- Analysis of data from consecutive robotic liver resections (RLR) since the initiation of our HPB robotic program in 2017 were analyzed and compared to consecutive open resections (OLR) from 2016. Exclusion criteria included combined liver and bowel resection, liver resection requiring biliary reconstruction, hepatectomy for living donation, and cyst fenestration. Twenty-seven liver resections were performed in 2016 (89% open, 11% laparoscopic, 0% robotic) and 34 in 2017 (53% open, 0% laparoscopic, 47% robotic). A total of 24 OLR were compared to 16 RLR. Mean age and BMI were similar between the two groups.
5. Intervention- Robotic liver resection
6. Main Outcome Measures- Patient-centric metrics including narcotic usage, length of stay, procedural time, and complications were compared between the two groups.
7. Results- Robotic patients had a higher proportion of Childs A cirrhosis (RL 50%, OL 8.3%; p=0.003). Resection rates for malignancy were similar (RL 81%, OL 83%). Procedural time was significantly longer in robotic cases (246 vs 153 minutes; p=0.003). Duration of postoperative narcotic requirement (epidural and intravenous) was shorter in RL patients (40 vs 82 hours; p=0.012). Correspondingly, length of stay in RL patients was shorter (4.5 days) compared to OL patients (7.3 days). Clavien III-V complications (16.7% OL vs 6.2% RL; p=0.212) & readmission rates were similar.
8. Conclusion- Utilization of robotic techniques for liver resection offers patients a significant benefit in the postoperative period with diminished narcotic requirements and shortened length of stay without compromising complication and readmission rates.
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