Impact of patient factors on outcomes in robotic major and minor hepatectomy: Importance of patient selection

Introduction : Robotic approach to hepatectomy has shown promise in recent times. The aim of our study was to identify the impact of various patient variables on outcomes from robotic major and minor hepatectomy. Methods : Data on 167 consecutive robotic hepatectomy procedures at our institution was retrospectively analyzed. Perioperative outcomes were analyzed for both minor and major hepatectomy. Results : For major hepatectomy (n = 66), factors associated with increased operative time included cirrhosis (301 vs 257min) and obesity (310 vs 261min). Estimated blood loss (EBL) was worse in patients with underlying cirrhosis (242 vs 161 mL), obesity (215 vs 148mL) and tumor size ≥ 10cm (232 vs 136mL). Length of hospital stay (LOS) was also longer with age ≥ 70 years (5.9 vs 4.5 days), cirrhosis (5.6 vs 4.6 days) and malignant tumor pathology (5.1 vs 3.8 days). Similarly, increased postoperative complications were seen with cirrhosis and tumor size ≥ 10cm. For minor hepatectomy (n = 101), operative time was longer in patients with cirrhosis (139 vs 105min), obesity (141 vs 115 min) and posterior-superior (PS) liver resection (168 vs 104 min). Similarly, EBL was higher in cirrhotic patients (163 vs 58mL) and those with PS resection (152 vs 64mL). Longer LOS was observed in elderly patients (2.9 vs 2.0 days), cirrhosis (2.9 vs 2.1 days) and PS resection (2.8 vs 2.1 days). Conclusion : Our study offers a comprehensive understanding of the impact of clinicopathologic factors on outcomes and can be utilized as a guide to appropriate patient selection, especially for surgeons starting a robotic hepatectomy practice.