24 - ANALYSIS OF CLINICAL OUTCOMES AFTER ROBOTIC HEPATECTOMY APPLYING THE WESTERN-MODEL SOUTHAMPTON LAPAROSCOPIC DIFFICULTY SCORING SYSTEM. AN EXPERIENCE FROM A TERTIARY US HEPATOBILIARY CENTER

Objectives: The ability to recognize liver resections with high risks of intraoperative complications is crucial to help guide patient selection for a minimally invasive approach. Japanese and European laparoscopic difficulty scoring systems have been developed to try to address this issue, but applicability and validity of these laparoscopic scoring systems to robotic hepatectomy seems ambitious without supporting data. We, therefore, undertook this study to evaluate the validity of the Southampton laparoscopic difficulty scoring system with robotic hepatectomy.

Methods: 312 consecutive patients undergoing robotic hepatectomies from 2016 to 2022 were scored based on five clinical risk factors including neoadjuvant chemotherapy status, prior liver resection, tumor type, size, and type of resection. The patients were then grouped into four risk categories: low, moderate, high, and extremely high of developing intraoperative complications; clinical outcomes of the groups were then compared.

Results: Prior liver resection, tumor size, operative duration, estimated blood loss, and major resection were significantly associated with the risk of developing intraoperative complications (all p<.0001) based on regression analyses. Postoperatively, however, there were no correlations between the risk category and the clinical outcomes including unplanned conversion to ‘open’ (p=0.78), Clavien-Dindo complication score ≥III (p=0.60), 30-day mortality (p=0.14), length of stay (p=0.65), and 30-day hospital readmission (p=0.51). There was also no correlation between the risk category and total cost (p=0.55), variable cost (p=0.31), fixed direct cost (p=0.11), fixed indirect cost (p=0.94), as well as hospital reimbursement (p=0.27) (Table). At 1 and 3 years, the overall survival for colorectal liver metastasis was 85%/62%, intrahepatic cholangiocarcinoma 77%/57%, and hepatocellular carcinoma 82%/58%.

Conclusion: Using our large number of patients undergoing robotic hepatectomy, the Southampton difficulty scoring system accurately predicts intra- but not postoperative outcomes after robotic hepatectomy. A dedicated difficulty scoring system should be developed uniquely for robotic hepatectomy.