E295: Robotic Major and Minor Hepatectomy: Impact of clinicopathologic factors on perioperative and short-term outcomes

Introduction: The robotic approach to hepatectomy has shown promise in recent times.  The aim of our study was to identify the impact of various patient-derived variables on surgical outcomes from robotic major and minor hepatectomy.

Methods: Between 2017 and 2021, data on 167 consecutive robotic hepatectomy procedures performed at our institution were retrospectively analyzed.  Outcomes were analyzed in relation to clinicopathological characteristics for both minor (n=101) and major (n=66) hepatectomy.

Results: For major hepatectomy, factors associated with increased operative time included underlying cirrhosis (301 vs 257 min, p = 0.036) and body mass index (BMI) ≥30 kg/m2 (310 vs 261 min, p = 0.022).  Estimated blood loss (EBL) was also significantly worse in patients with cirrhosis (242 vs 161 mL, p = 0.028), BMI ≥30 kg/m2 (215 vs 148 mL, p = 0.031) and tumor size ≥10 cm (232 vs 136 mL, p = 0.001).  Length of hospital stay (LOS) was adversely associated with age ≥70 years (5.9 vs 4.5 days, p = 0.036), cirrhosis (5.6 vs 4.6 days, p = 0.045) and malignant tumor pathology (5.1 vs 3.8 days, p = 0.029).  Similarly, factors associated with postoperative complications included cirrhosis (OR 3.53, p = 0.018) and tumor size ≥10 cm (OR 3.13, p = 0.024).  No association was seen with mortality or 30-day hospital readmission.
In minor hepatectomy, operative time was longer with cirrhosis (139 vs 105min, p=0.048), BMI ≥30 kg/m2 (141 vs 115 min, p=0.032) and with resection of posterior-superior liver segments (168 vs 104 min, p=0.001). Similarly EBL was higher in cirrhotic patients (163 vs 98mL, p=0.041) and those with tumors in posterior-superior segments (152 vs 84mL, p< 0.001). Hospital LOS was significantly longer in elderly patients (2.9 vs 2.1 days, p=0.019) and patients undergoing posterior superior segmental resection (2.7 vs 2.1 days, p=0.027). No difference was seen in complication rate, mortality or 30-day readmission.

Conclusions: Our study helps to reaffirm the safety and viability of robotic hepatectomy.  Additionally, it allows for a better understanding of the impact of clinicopathologic factors on perioperative and short-term outcomes.