Robotic versus laparoscopic liver resection for difficult posterosuperior segments: a systematic review with a meta-analysis of propensity-score matched studies

Background: The outcomes of minimally invasive liver surgery for posterosuperior segments (PS) are still debated. Since the results of ongoing trials focusing on the results of laparoscopic liver resection (LLR) and robotic liver resection (RLR) in this setting are still awaited, the best evidence currently comes from retrospective propensity-score matched (PSM) studies. The aim of this meta-analysis was to assess the outcomes of RLR for difficult located lesions and to provide evidence for its use in clinical practice. Methods: A systematic review with meta-analysis was conducted to evaluate the safety and efficacy of LLR and RLR for PS segments. The Medline, Embase and Web of Science Library electronic databases were searched to identify available research published up to June 2024. Results: Five studies with a total of 2907 patients (RLR: n = 1084; LLR: n = 1823) were included in the meta-analysis. The RLR group had less estimated blood loss (EBL) (MD: − 88.3, 95% CI − 144.2–− 32.3; p = 0.012), fewer blood transfusions (OR 0.70, 95% CI 0.39–0.80, p = 0.033), and a shorter operative time (MD − 27.3, 95% CI − 49.4–− 5.1; p = 0.027). No differences in postoperative morbidity, mortality and R1 resection rates were observed. Conclusion: RLR for lesions in the PS segments are safe and effective, and may have superior surgical outcomes than LLR.