Outcomes of Liver Resection after Previous Abdominal and/or Liver Operations Utilizing the Robotic Platform: Does Surgical History Matter?

Abstract

Introduction: As the safety and feasibility of liver resection increases, more patients become eligible for primary or reoperative liver resection. This study was undertaken to examine outcomes of patients undergoing robotic liver resection with varying surgical history. Methods: With IRB approval, we prospectively followed 234 patients who underwent robotic liver resection from 2012 to 2021. Patients were separated by their previous abdominal surgical history. To compare cohorts, one-way ANOVA and 2x3 contingency table analyses were utilized with significance accepted at p≤0.05. Data are presented as median (mean±SD). Results: Of the 234 patients who underwent a robotic hepatectomy, 114 underwent primary hepatectomy, 105 had a previous abdominal operation, and 15 had a redo hepatectomy. Patient population was 54% women, who were 63(61±13.7) years-old with a BMI of 28(29±6.2)kg/m2 and ASA class of 3(3±0.5), (p=NS). Overall, estimated blood loss(EBL) was 150(225±257.6)mL, operative duration was 256(288±122.4)minutes, and length of stay(LOS) was 4(5±3.5)days. 12(5%) patients experienced postoperative complications with a Clavien-Dindo classification ≥III. Within 30 days of resection, there were 3(1%) mortalities and 41(18%) readmissions. Conclusion: Demographics, operative duration, EBL, LOS, ICU LOS, serious postoperative complications, 30-day mortality, and 30-day readmissions were similar among the cohorts. There was no significant difference in outcomes of patients who had a primary resection, a previous abdominal operation, and/or a previous liver resection. We believe that the application of the robotic approach can facilitate safe minimally invasive liver resection regardless of previous operations.