100 Robotic Liver Resections for HCC: Lesson Learned

Abstract

Introduction: Minimally invasive approach to the liver reduces the risks of post-operative complications compared to the traditional open approach. We report our experience with robotic liver resection (RLR) in patients affected by hepatocellular carcinoma (HCC). Methods: This is a single center, retrospective study on prospectively collected data, including all consecutive patients treated for HCC with RLR from June 2014 to May 2021. Results: 201 RLR were performed in the study period and 100 patients affected by HCC were enrolled. Mean age of the patients was 64.7, 70% were cirrhotic, 11% of whom were Child-B patients and 25% with clinically significant portal hypertension (CSPH). Mean BMI was 27.22, with 6.7 mean Charlson morbidity index. 14% were major hepatectomies, 60% minor and 26% wedge resections, and 4 patients needed conversion to open. Mean operative time was 277 minutes, with 367.3 ml mean estimated blood loss. Clavien-Dindo morbidity >3a was 4%, and mean in-hospital stay was 4.77 days. Mean tumor size on final pathology was 34.2 mm, with mean surgical margin of 9.4 mm. Overall survival (OS) at 1- and 3-years were 95% and 91%, respectively, while disease free survival (DSF) were 80% and 70%. Conclusions: Our study shows in a large cohort that robotic approach is safe and feasible in cirrhotic patients affected by HCC, even in presence of CSPH, with good short- and long-term results. Thanks to the reduced morbidity, RLR may play a role as a downstaging strategy, expanding the spectrum of potential candidates to radical surgical resection.