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Background &amp; aims <p>Resection of tumors located in the posterosuperior liver segments (I, IVa, VII, VIII) presents significant technical challenges during laparoscopic liver resection (LLR) due to restricted instrument maneuverability and suboptimal surgical ergonomics. Robotic liver resection (RLR) may overcome these limitations through enhanced dexterity and superior visualization. This <b>systematic review and meta-analysis of propensity score-matched (PSM) studies</b> aimed to compare intraoperative safety, postoperative outcomes, and oncological adequacy between RLR and LLR for tumors in these challenging anatomical locations.</p> Methods <p>Following PRISMA 2020 guidelines, we conducted a comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science through March 2024. Studies employing propensity score matching to compare RLR and LLR for posterosuperior segment tumors were included. Primary endpoints were intraoperative blood loss and conversion rates; secondary outcomes included operative time, transfusion requirements, perioperative morbidity and mortality, R0 resection rates, and hospital stay duration. Random-effects models were used to calculate pooled odds ratios (OR) and weighted mean differences (WMD).</p> Results <p>Eight PSM studies including 11,364 patients (RLR: 2,289; LLR: 9,075) were included. RLR demonstrated significantly reduced blood loss (WMD: -121.8 mL; 95% CI: -185.6 to -58.0; <i>P</i> = 0.0002), lower conversion rates (OR: 0.37; 95% CI: 0.28–0.49; <i>P</i> &lt; 0.00001), shorter operative time (WMD: -28.4&#xa0;min; 95% CI: -41.2 to -15.6; <i>P</i> &lt; 0.0001), and decreased transfusion requirements (OR: 0.58; 95% CI: 0.45–0.75; <i>P</i> &lt; 0.0001). No significant differences were observed in major morbidity, bile leakage, mortality, R0 resection rates, or length of hospital stay.</p> Conclusion <p>For tumors in posterosuperior liver segments, RLR provides superior intraoperative outcomes compared to LLR—including better hemostatic control, reduced conversion rates, and improved operative efficiency—while maintaining equivalent postoperative recovery and oncological safety. Robotic surgery represents a technically advantageous approach for these complex resections.</p>

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Propensity score-matched systematic review and meta-analysis: Robotic versus laparoscopic limited liver resections for tumors in the posterosuperior segments

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Danilo Coco,
  • Silvana Leanza

摘要

Background & aims

Resection of tumors located in the posterosuperior liver segments (I, IVa, VII, VIII) presents significant technical challenges during laparoscopic liver resection (LLR) due to restricted instrument maneuverability and suboptimal surgical ergonomics. Robotic liver resection (RLR) may overcome these limitations through enhanced dexterity and superior visualization. This systematic review and meta-analysis of propensity score-matched (PSM) studies aimed to compare intraoperative safety, postoperative outcomes, and oncological adequacy between RLR and LLR for tumors in these challenging anatomical locations.

Methods

Following PRISMA 2020 guidelines, we conducted a comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science through March 2024. Studies employing propensity score matching to compare RLR and LLR for posterosuperior segment tumors were included. Primary endpoints were intraoperative blood loss and conversion rates; secondary outcomes included operative time, transfusion requirements, perioperative morbidity and mortality, R0 resection rates, and hospital stay duration. Random-effects models were used to calculate pooled odds ratios (OR) and weighted mean differences (WMD).

Results

Eight PSM studies including 11,364 patients (RLR: 2,289; LLR: 9,075) were included. RLR demonstrated significantly reduced blood loss (WMD: -121.8 mL; 95% CI: -185.6 to -58.0; P = 0.0002), lower conversion rates (OR: 0.37; 95% CI: 0.28–0.49; P < 0.00001), shorter operative time (WMD: -28.4 min; 95% CI: -41.2 to -15.6; P < 0.0001), and decreased transfusion requirements (OR: 0.58; 95% CI: 0.45–0.75; P < 0.0001). No significant differences were observed in major morbidity, bile leakage, mortality, R0 resection rates, or length of hospital stay.

Conclusion

For tumors in posterosuperior liver segments, RLR provides superior intraoperative outcomes compared to LLR—including better hemostatic control, reduced conversion rates, and improved operative efficiency—while maintaining equivalent postoperative recovery and oncological safety. Robotic surgery represents a technically advantageous approach for these complex resections.