Does preoperative MELD score affect outcomes following robotic hepatectomy for liver tumors?
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ORIGINAL ARTICLE
Does preoperative MELD score affect outcomes following robotic hepatectomy for liver tumors? Iswanto Sucandy1 · Andres Giovannetti1 · Janelle Spence1 · Sharona Ross1 · Alexander Rosemurgy1 Received: 27 October 2019 / Accepted: 18 January 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The model for end-stage liver disease (MELD) score is objective, reproducible, and it has shown to predict mortality related to cirrhosis. This study was undertaken to investigate safety of robotic hepatectomy in patients with elevated preoperative MELD score and to examine correlation between preoperative MELD scores and postoperative outcomes after robotic hepatectomy for liver tumors. Demographic data, MELD score, and clinical outcomes were prospectively collected. Regression analysis was used. Data are presented as median (mean ± SD). 75 patients underwent robotic hepatectomy. Age was 64 (62.5 ± 14.2) years and BMI 28 (29 ± 7.0) kg/m2; 56% women. 60 (81%) of the hepatectomies were undertaken for malignancy (25% hepatocellular carcinoma, 20% colorectal metastasis, 15% cholangiocarcinoma). On regression analysis, MELD score did not correlate with operative time (p = 0.518) or blood loss (p = 0.583). MELD score, however, correlated with length of stay (p = 0.002). 8 (11%) patients experienced postoperative complications; their MELD score was 7 (8 ± 2.5). 68 (91%) patients did not experience postoperative complications; their MELD score was 7 (8 ± 2.8) (p = 0.803). One patient died in this series. In patients undergoing robotic hepatectomy to treat liver tumors, preoperative MELD score only correlates with length of stay. Preoperative MELD score does not correlate with operative time and amount of blood loss. An elevated MELD score should not deter surgeons from offering robotic hepatectomy. Keywords Robotic liver resection · Hepatectomy · Outcomes · MELD score
Introduction Minimally invasive hepato-pancreato-biliary (HPB) surgery has evolved since its introduction in 1992, when the first laparoscopic liver wedge resection was undertaken by Gagner et al. [1]. Since then, many studies have described feasibility, safety, and advantages of minimally invasive technique compared to the well-established conventional “open” approach [2, 3]. In the HPB surgery, minimally invasive operations were limited to simple cholecystectomy for many years, with only few centers in the world undertaking more complex operations such as hepatectomy and pancreaticoduodenectomy. The slow dissemination and adoption of this approach Presented as an oral presentation at Academic Surgical Congress (ASC) 2019 in Houston Texas, USA. * Iswanto Sucandy [email protected] 1
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in liver surgery is mainly because of the technical complexity, concern of intraoperative bleeding, and fear of inferior oncological outcomes [3, 4]. The expertise of modern surgeons in addition to the newly developed sophisticated instruments including en
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