COMPARATIVE OUTCOME OF OPEN VS ROBOTICS ASSISTED SURGERY IN HEPATOBILIARY MALIGNANCIES
Main Article Content
Keywords
Hepatobiliary malignancies, Open surgery, Robotics-assisted surgery, R0 resection, Postoperative recovery, Surgical outcomes
Abstract
This review presents a detailed comparison of open surgery and robotics-assisted surgery in the treatment of hepatobiliary malignancies. Conventional open surgery remains the standard of care in managing large complex tumors because it allows for visual, and palpation based intraoperative assessment of the resection margins and extent of tumor clearance crucial in achieving a R0 resection. But it is linked with increased risk of postoperative complications such as Surgical Site Infection, Wound dehiscence and hemorrhagic events and more hospital stay and longer time to recovery. On the other hand, robotics assisted surgery uses less invasive approaches that improve the accuracy, flexibility and visibility of surgeries using high-definition stereoscopic vision. This modality is linked with reduced intraoperative blood loss, decreased post-operative complications and shortened time for the recovery, because of the decreased inflammation processes and enhanced local tissue repair. At the same time, high costs of robotic systems and long years needed for the surgeon to master the system remain the major challenges that limit the application of robotic surgery. This review makes it clear that, though the oncological results of both surgical approaches are similar in terms of OS and DFS, open surgery is often chosen for extensive resections because of its effectiveness. The growth of robotics-assisted surgery is expected to increase over time due to the development of technologies that make the costs of surgeries less costly and more accessible. Further studies are necessary to determine the oncological outcome, including local recurrence and disease-free survival, as well as the quality of life of the patients. Therefore, the selection of the surgical approach should be personalized based on the patients and tumor characteristics and the resources available at the particular center.
References
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27. Zhang, X. P., Xu, S., Hu, M. G., Zhao, Z. M., Wang, Z. H., Zhao, G. D., ... & Liu, R. (2022). Short-and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study. Surgical Endoscopy, 36(11), 8132-8143.
28. Ding, D. L., Zhang, Q. J., & Chen, X. L. (2020). Recent advances in robotic surgery for liver tumors: a review. Frontiers in Surgery, 7, 63.
29. Hsu, C. Y., Lee, H. C., Chen, C. C., & Chen, M. T. (2022). Robotic liver resection: A systematic review and meta-analysis. Journal of Robotic Surgery, 16(4), 481-491
30. Aziz, H., Wang, J. C., Genyk, Y., & Sheikh, M. R. (2022). Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database. Journal of Robotic Surgery, 16(2), 401-407.
31. Caruso, R., Vicente, E., Núñez-Alfonsel, J., Ferri, V., Diaz, E., Fabra, I., ... & Quijano, Y. (2020). Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-effectiveness analysis. Journal of Robotic Surgery, 14(4), 627-632.
32. Montalti, R., Berardi, G., Patriti, A., Vivarelli, M., & Troisi, R. I. (2015). Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World Journal of Gastroenterology: WJG, 21(27), 8441.
33. Daskalaki, D., Gonzalez-Heredia, R., Brown, M., Bianco, F. M., Tzvetanov, I., Davis, M., ... & Giulianotti, P. C. (2017). Financial impact of the robotic approach in liver surgery: a comparative study of clinical outcomes and costs between the robotic and open technique in a single institution. Journal of Laparoendoscopic & Advanced Surgical Techniques, 27(4), 375-382.
34. Rivero-Moreno, Y., Echevarria, S., Vidal-Valderrama, C., Pianetti, L., Cordova-Guilarte, J., Navarro-Gonzalez, J., ... & Acero-Alvarracín, K. (2023). Robotic surgery: a comprehensive review of the literature and current trends. Cureus, 15(7).
35. Xu, Y., & Lu, X. (2019). Surgical treatment of primary hepatocellular carcinoma with intrapericardial tumor thrombus without extracorporeal circulation. Hepatobiliary Surgery and Nutrition, 8(4), 419.
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37. Machairas, N., Papaconstantinou, D., Tsilimigras, D. I., Moris, D., Prodromidou, A., Paspala, A., ... & Kostakis, I. D. (2019). Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates in Surgery, 71, 39-48.
38. Pesi, B., Bencini, L., Moraldi, L., Tofani, F., Batignani, G., Bechi, P., ... & Coratti, A. (2021). Robotic versus open liver resection in hepatocarcinoma: surgical and oncological outcomes. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 31(4), 468-474.
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43. Sridhar, A. N., Briggs, T. P., Kelly, J. D., & Nathan, S. (2017). Training in robotic surgery—an overview. Current Urology Reports, 18, 1-8.
44. Kaul, S., Shah, N. L., & Menon, M. (2006). Learning curve using robotic surgery. Current Urology Reports, 7(2), 125-129.
45. Starble, E. (2018). Implications of robotic surgery. Harvard Public Health Review, 14, 1-25.
46. Younes, M. M., Larkins, K., To, G., Burke, G., Heriot, A., Warrier, S., & Mohan, H. (2023). What are clinically relevant performance metrics in robotic surgery? A systematic review of the literature. Journal of Robotic Surgery, 17(2), 335-350.
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48. Pal, H. (2024). Advancements and limitations in integrating robotics into medicine: A comprehensive review. Multidisciplinary Reviews, 7(11), 2024248-2024248
49. Kabbach, G., Assi, H. A., Bolotin, G., Schuster, M., Lee, H. J., & Tadros, M. (2015). Hepatobiliary Tumors: Update on Diagnosis and Management. Journal of Clinical and Translational Hepatology, 3(3), 169–181. https://doi.org/10.14218/jcth.2015.00012
50. Husarova, T., MacCuaig, W. M., Dennahy, I. S., Sanderson, E. J., Edil, B. H., Jain, A., Bonds, M. M., McNally, M. W., Menclova, K., Pudil, J., Zaruba, P., Pohnan, R., Henson, C. E., Grizzle, W. E., & McNally, L. R. (2023). Intraoperative Imaging in Hepatopancreatobiliary Surgery. Cancers, 15(14), 3694. https://doi.org/10.3390/cancers15143694
51. Outreach, R. (2023, November 8). Robotics: the future of liver surgery? Research Outreach. https://researchoutreach.org/articles/robotics-the-future-of-liver-surgery
2. Ciria, R., Gomez-Luque, I., Ocana, S., Cipriani, F., Halls, M., Briceno, J., ... & Abu Hilal, M. (2019). A systematic review and meta-analysis comparing the short-and long-term outcomes for laparoscopic and open liver resections for hepatocellular carcinoma: updated results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017. Annals of Surgical Oncology, 26, 252-263.
3. Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery, 240(2), 205-213.
4. Yu, M. C., Yuan, J. M., Govindarajan, S., & Ross, R. K. (2000). Epidemiology of hepatocellular carcinoma. Canadian Journal of Gastroenterology and Hepatology, 14(8), 703-709.
5. Machairas, N., Papaconstantinou, D., Tsilimigras, D. I., Moris, D., Prodromidou, A., Paspala, A., ... & Kostakis, I. D. (2019). Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates in Surgery, 71, 39-48.
6. Bertens, K. A., Abt, P., & van der Spoel, H. (2020). The role of robotic-assisted surgery in hepatobiliary cancer. Surgical Oncology, 35, 39-46.
7. Moukarbel, R. V., Geisinger, A. R., & Hegazy, Y. (2018). Robotic surgery in liver resection: current status and future perspectives. Surgical Clinics of North America, 98(5), 949-964.
8. Liu, C. L., Lo, C. M., & Lai, E. C. (2021). Robotic-assisted liver surgery: costs and outcomes. Hepatology International, 15, 763-771.
9. Luo, Y., Xu, X., & Liu, Z. (2020). A comparison of surgical outcomes between robotic and laparoscopic liver resection: a meta-analysis. Surgery, 167(1), 106-114.
10. Song, T. J., Ip, E. W. K., & Fong, Y. (2004). Hepatocellular carcinoma: current surgical management. Gastroenterology, 127(5), S248-S260.
11. Patel, S. H., Tsilimigras, D. I., & Moris, D. (2020). Robotic versus open liver resection: A systematic review and meta-analysis of short- and long-term outcomes. International Journal of Surgery, 79, 230-243.
12. Hwang, D. W., Han, H. S., Yoon, Y. S., Cho, J. Y., Kwon, Y., Kim, J. H., ... & Park, S. J. (2013). Laparoscopic major liver resection in Korea: a multicenter study. Journal of Hepato‐Biliary‐Pancreatic Sciences, 20(2), 125-130.
13. Ellis, L. M., Demers, M. L., & Roh, M. S. (1992). Current strategies for the treatment of hepatocellular carcinoma. Current Opinion in Oncology, 4(4), 741-752.
14. Sidhu, R., Turnbull, D., Haboubi, H., Leeds, J. S., Healey, C., Hebbar, S., ... & Penman, I. (2024). British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut, 73(2), 219-245.
15. Padmanaban, V., Johnston, P. F., Gyakobo, M., Benneh, A., Esinam, A., & Sifri, Z. C. (2020). Long-term follow-up of humanitarian surgeries: outcomes and patient satisfaction in rural Ghana. Journal of Surgical Research, 246, 106-112.
16. Benson, A. B., D’Angelica, M. I., Abbott, D. E., Anaya, D. A., Anders, R., Are, C., ... & Darlow, S. D. (2021). Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 19(5), 541-565.
17. Yamazaki, S., & Takayama, T. (2017). Management strategies to minimize mortality in liver resection for hepatocellular carcinoma. Japanese Journal of Clinical Oncology, 47(10), 899-908.
18. Calò, P., Catena, F., Corsaro, D., Costantini, L., Falez, F., Moretti, B., ... & Venneri, F. (2023). Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review. Discover Health Systems, 2(1), 6.
19. Tebala, G. D. (2015). History of colorectal surgery: A comprehensive historical review from the ancient Egyptians to the surgical robot. International Journal of Colorectal Disease, 30, 723-748.
20. Ueno, M., Morizane, C., Ikeda, M., Okusaka, T., Ishii, H., & Furuse, J. (2019). A review of changes to and clinical implications of the eighth TNM classification of hepatobiliary and pancreatic cancers. Japanese Journal of Clinical Oncology, 49(12), 1073-1082.
21. Fagenson, A. M., Pitt, H. A., Moten, A. S., Karhadkar, S. S., Di Carlo, A., & Lau, K. N. (2021). Fatty liver: the metabolic syndrome increases major hepatectomy mortality. Surgery, 169(5), 1054-1060.
22. Calderon Novoa, F., Ardiles, V., de Santibañes, E., Pekolj, J., Goransky, J., Mazza, O., ... & de Santibañes, M. (2023). Pushing the limits of surgical resection in colorectal liver metastasis: how far can we go? Cancers, 15(7), 2113.
23. Ji, J., Mi, S., Hou, Z., Zhang, Z., Qiu, G., Jin, Z., & Huang, J. (2024). Impact of imaging-diagnosed sarcopenia on outcomes in patients with biliary tract cancer after surgical resection: a systematic review and meta-analysis. World Journal of Surgical Oncology, 22(1), 229
24. Aziz, H., Wang, J. C., Genyk, Y., & Sheikh, M. R. (2022). Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database. Journal of Robotic Surgery, 16(2), 401-407.
25. Caruso, R., Vicente, E., Núñez-Alfonsel, J., Ferri, V., Diaz, E., Fabra, I., ... & Quijano, Y. (2020). Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-effectiveness analysis. Journal of Robotic Surgery, 14(4), 627-632.
26. Montalti, R., Berardi, G., Patriti, A., Vivarelli, M., & Troisi, R. I. (2015). Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World Journal of Gastroenterology: WJG, 21(27), 8441.
27. Zhang, X. P., Xu, S., Hu, M. G., Zhao, Z. M., Wang, Z. H., Zhao, G. D., ... & Liu, R. (2022). Short-and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study. Surgical Endoscopy, 36(11), 8132-8143.
28. Ding, D. L., Zhang, Q. J., & Chen, X. L. (2020). Recent advances in robotic surgery for liver tumors: a review. Frontiers in Surgery, 7, 63.
29. Hsu, C. Y., Lee, H. C., Chen, C. C., & Chen, M. T. (2022). Robotic liver resection: A systematic review and meta-analysis. Journal of Robotic Surgery, 16(4), 481-491
30. Aziz, H., Wang, J. C., Genyk, Y., & Sheikh, M. R. (2022). Comprehensive analysis of laparoscopic, robotic, and open hepatectomy outcomes using the nationwide readmissions database. Journal of Robotic Surgery, 16(2), 401-407.
31. Caruso, R., Vicente, E., Núñez-Alfonsel, J., Ferri, V., Diaz, E., Fabra, I., ... & Quijano, Y. (2020). Robotic-assisted gastrectomy compared with open resection: a comparative study of clinical outcomes and cost-effectiveness analysis. Journal of Robotic Surgery, 14(4), 627-632.
32. Montalti, R., Berardi, G., Patriti, A., Vivarelli, M., & Troisi, R. I. (2015). Outcomes of robotic vs laparoscopic hepatectomy: a systematic review and meta-analysis. World Journal of Gastroenterology: WJG, 21(27), 8441.
33. Daskalaki, D., Gonzalez-Heredia, R., Brown, M., Bianco, F. M., Tzvetanov, I., Davis, M., ... & Giulianotti, P. C. (2017). Financial impact of the robotic approach in liver surgery: a comparative study of clinical outcomes and costs between the robotic and open technique in a single institution. Journal of Laparoendoscopic & Advanced Surgical Techniques, 27(4), 375-382.
34. Rivero-Moreno, Y., Echevarria, S., Vidal-Valderrama, C., Pianetti, L., Cordova-Guilarte, J., Navarro-Gonzalez, J., ... & Acero-Alvarracín, K. (2023). Robotic surgery: a comprehensive review of the literature and current trends. Cureus, 15(7).
35. Xu, Y., & Lu, X. (2019). Surgical treatment of primary hepatocellular carcinoma with intrapericardial tumor thrombus without extracorporeal circulation. Hepatobiliary Surgery and Nutrition, 8(4), 419.
36. Wong, D. J., Wong, M. J., Choi, G. H., Wu, Y. M., Lai, P. B., & Goh, B. K. (2019). Systematic review and meta‐analysis of robotic versus open hepatectomy. ANZ Journal of Surgery, 89(3), 165-170.
37. Machairas, N., Papaconstantinou, D., Tsilimigras, D. I., Moris, D., Prodromidou, A., Paspala, A., ... & Kostakis, I. D. (2019). Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates in Surgery, 71, 39-48.
38. Pesi, B., Bencini, L., Moraldi, L., Tofani, F., Batignani, G., Bechi, P., ... & Coratti, A. (2021). Robotic versus open liver resection in hepatocarcinoma: surgical and oncological outcomes. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 31(4), 468-474.
39. Di Benedetto, F., Magistri, P., Di Sandro, S., Sposito, C., Oberkofler, C., Brandon, E., ... & Robotic HPB Study Group. (2023). Safety and efficacy of robotic vs open liver resection for hepatocellular carcinoma. JAMA Surgery, 158(1), 46-54.
40. Jara, R. D., Guerrón, A. D., & Portenier, D. (2020). Complications of robotic surgery. Surgical Clinics, 100(2), 461-468.
41. Chuang, S. H., & Lin, C. S. (2016). Single-incision laparoscopic surgery for biliary tract disease. World Journal of Gastroenterology, 22(2), 736.
42. Zhang, X. P., Xu, S., Hu, M. G., Zhao, Z. M., Wang, Z. H., Zhao, G. D., ... & Liu, R. (2022). Short-and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study. Surgical Endoscopy, 36(11), 8132-8143
43. Sridhar, A. N., Briggs, T. P., Kelly, J. D., & Nathan, S. (2017). Training in robotic surgery—an overview. Current Urology Reports, 18, 1-8.
44. Kaul, S., Shah, N. L., & Menon, M. (2006). Learning curve using robotic surgery. Current Urology Reports, 7(2), 125-129.
45. Starble, E. (2018). Implications of robotic surgery. Harvard Public Health Review, 14, 1-25.
46. Younes, M. M., Larkins, K., To, G., Burke, G., Heriot, A., Warrier, S., & Mohan, H. (2023). What are clinically relevant performance metrics in robotic surgery? A systematic review of the literature. Journal of Robotic Surgery, 17(2), 335-350.
47. Boal, M. W., Anastasiou, D., Tesfai, F., Ghamrawi, W., Mazomenos, E., Curtis, N., ... & Francis, N. K. (2024). Evaluation of objective tools and artificial intelligence in robotic surgery technical skills assessment: a systematic review. British Journal of Surgery, 111(1), znad331.
48. Pal, H. (2024). Advancements and limitations in integrating robotics into medicine: A comprehensive review. Multidisciplinary Reviews, 7(11), 2024248-2024248
49. Kabbach, G., Assi, H. A., Bolotin, G., Schuster, M., Lee, H. J., & Tadros, M. (2015). Hepatobiliary Tumors: Update on Diagnosis and Management. Journal of Clinical and Translational Hepatology, 3(3), 169–181. https://doi.org/10.14218/jcth.2015.00012
50. Husarova, T., MacCuaig, W. M., Dennahy, I. S., Sanderson, E. J., Edil, B. H., Jain, A., Bonds, M. M., McNally, M. W., Menclova, K., Pudil, J., Zaruba, P., Pohnan, R., Henson, C. E., Grizzle, W. E., & McNally, L. R. (2023). Intraoperative Imaging in Hepatopancreatobiliary Surgery. Cancers, 15(14), 3694. https://doi.org/10.3390/cancers15143694
51. Outreach, R. (2023, November 8). Robotics: the future of liver surgery? Research Outreach. https://researchoutreach.org/articles/robotics-the-future-of-liver-surgery
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Oct 16, 2024
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Kailash Chand Sharma, & Kamlesh Agarwal. (2024). COMPARATIVE OUTCOME OF OPEN VS ROBOTICS ASSISTED SURGERY IN HEPATOBILIARY MALIGNANCIES. Journal of Population Therapeutics and Clinical Pharmacology, 31(10), 336-349. https://doi.org/10.53555/kvv7nm11
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Author Biographies
Kailash Chand Sharma
Assistant Professor, Department of General Surgery, National Institute of Medical Sciences & Research, Jaipur Rajasthan
Kamlesh Agarwal
Assistant Professor, Department of General Surgery, National Institute of Medical Sciences & Research, Jaipur Rajasthan
How to Cite
Kailash Chand Sharma, & Kamlesh Agarwal. (2024). COMPARATIVE OUTCOME OF OPEN VS ROBOTICS ASSISTED SURGERY IN HEPATOBILIARY MALIGNANCIES. Journal of Population Therapeutics and Clinical Pharmacology, 31(10), 336-349. https://doi.org/10.53555/kvv7nm11