Textbook outcome after robotic vs. laparoscopic hepatectomy: a secondary post-hoc analysis of the randomized ROC‘N’ROLL trial
Background: Textbook outcome (TO) is a composite quality metric reflecting optimal perioperative care after surgery. Prospective randomized evidence on TO after minimally invasive and robotic liver surgery remains limited. The objective of this post-hoc secondary analysis was to compare the achievem...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
Apr 30, 2026
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| In: |
Hepatobiliary surgery and nutrition
Year: 2026, Pages: 1-10 |
| ISSN: | 2304-389X |
| DOI: | 10.21037/hbsn-2025-1-970 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.21037/hbsn-2025-1-970 Verlag, kostenfrei, Volltext: https://hbsn.amegroups.org/article/view/153091 
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| Author Notes: | Emrullah Birgin, Marie Heibel, Svetlana Hetjens, Erik Rasbach, Christoph Reissfelder, Patrick Téoule, Nuh N. Rahbari |
| Summary: | Background: Textbook outcome (TO) is a composite quality metric reflecting optimal perioperative care after surgery. Prospective randomized evidence on TO after minimally invasive and robotic liver surgery remains limited. The objective of this post-hoc secondary analysis was to compare the achievement of TO after robotic hepatectomy (RH) versus laparoscopic hepatectomy (LH) and to evaluate the association between TO and patient-reported outcomes (PROs). Methods: This post hoc secondary analysis of the randomized ROC‘N’ROLL trial included 80 adult patients undergoing minimally invasive hepatectomy for liver malignancies and was not powered for TO as primary endpoint. TO was defined according to international consensus criteria. PROs were assessed using EQ-5D-5L and EORTC QLQ-C30 questionnaires up to 90 days postoperatively. Multivariable logistic regression was used to identify factors associated with TO. Results: Among 80 patients (median age, 66 years; 59% male), 41 underwent RH and 39 LH. TO was achieved in 58 patients (73%), more frequently after RH than LH (83% vs. 62%, absolute risk difference 21%, P=0.045). On multivariable analysis, RH [odds ratio (OR) 7.09, 95% confidence interval (CI): 1.59–31.60] and minor hepatectomy (OR 12.0, 95% CI: 1.74–82.90) were independently associated with TO. Patients achieving TO reported significantly better global health status, functional scores, and lower symptom burden on PRO assessments. Conclusions: In this post-hoc analysis of a randomized trial, RH was associated with a higher likelihood of achieving TO compared with LH. Failure to achieve TO correlated with impaired patient-reported quality of life, supporting TO as a clinically meaningful surrogate endpoint after minimally invasive liver surgery. |
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| Item Description: | Gesehen am 16.06.2026 |
| Physical Description: | Online Resource |
| ISSN: | 2304-389X |
| DOI: | 10.21037/hbsn-2025-1-970 |