Goh, B.K.P. (Brian K. P.)

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    Association of laparoscopic surgery with improved perioperative and survival outcomes in patients with resectable intrahepatic cholangiocarcinoma: A systematic seview and meta-analysis from propensity-score matched studies
    (Springer, 2023) Goh, B.K.P. (Brian K. P.); Rotellar, F. (Fernando); Zozaya-Larequi, G. (Gabriel); Blanco, N. (Nuria); Marti-Cruchaga, P. (Pablo); Sapisochin, G. (Gonzalo); Aliseda, D. (Daniel)
    Background: Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC). Methods: A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model. Results: Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638-0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (- 161.47 ml [95% CI - 237.26 to - 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26-0.69]), as well as with a shorter hospital stay (- 3.16 days [95% CI - 4.98 to - 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39-0.93]). Conclusions: This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR.
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    Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases
    (2023) Goh, B.K.P. (Brian K. P.); Park, J.O. (James O.); Sutcliffe, R.P. (Robert P.); Kingham, T.P. (T. Peter); Wakabayashi, G. (Go); Herman, P. (Paulo); D'Hondt, M. (Mathieu); Lee, J.H. (Jae Hoon); Rotellar, F. (Fernando); Chiow, A.K.H. (Adrian K. H.); Cipriani, F. (Federica); Giuliante, F. (Felice); Fuks, D. (David); Aghayan, D.L. (Davit L.); Choi, G. (Gi-Hong); Troisi, R.I. (Roberto I.); Mejía, A. (Alejandro); Cheung, T.T. (Tan To); Di-Benedetto, F. (Fabrizio); Cherqui, D. (Daniel); Tang, C. N. (Chung-Ngai); Edwin, B. (Bjorn); Efanov, M. (Mikhail); Robles-Campos, R. (Ricardo); Scatton, O. (Oliver); Wang, X. (Xiaoying); Chen, K. (KuoHsin); Ferrero, A. (Alessandro); Abu-Hilal, M. (Mohammed); Chong, C.C.N (Charing C. N.); Fondevila, C. (Constantino); Choi, S.H. (Sung Hoon); López-Ben, S. (Santiago); Aldrighetti, L. (Luca); Marino, M.V. (Marco V.); Ruzzenente, A. (Andrea); Sucandy, I. (Iswanto); Han, H.S. (Ho-Seong); Liu, R. (Rong); Pratschke, J. (J.); Syn, N.L. (Nicholas L.); Mazzaferro, V. (Vicenzo); Sugioka, A. (Atsushi); Gastaca, M. (Mikel); Long, T.C.D. (Tran Cong Duy)
    Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours >_10 cm. Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (>_10 cm) tumors at 42 international centers between 2002-2020. Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs. 21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs. 6 days, P=0.435). Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.