Robotic Liver Resection versus Percutaneous Ablation for Single HCC: Short- and Long-term Results

Abstract

Introduction: Single hepatocellular carcinoma may be approached with different therapeutic strategies. The aim of this study is to compare short and long-term outcomes of patients that underwent robotic liver resection (RLR) versus percutaneous ablation (PA) for single HCC up to 3 cm. Methods: All consecutive patients presenting at our Institution, between January 2014 and October 2019, with a single HCC up to 3 cm, and treated by RLR or PA (radio frequency ablation [RFA] and microwave ablation [MWA]) were included in this retrospective study. Results: A total of 60 patients were collected, 24 patients underwent RLR and 36 PA. No significant differences were found between the two groups regarding demographics, underlying liver disease, liver reserve and characteristics of HCC. The overall complication rate was 37.50% in RLR-group and 16.67% in PA-group (p=0.068). No early reinterventions were observed, and 30-day mortality was 0% in both groups. The incidence recurrence was 16.67% in RLR-group and 55.56% in PA-group (p=0.003), including residual disease and all-site recurrence., Disease free survival and overall survival at 3 years in RLR-group and PA-group were 75% vs 33.3 % (p=0.017) and 63.6% vs 40% (p=0.650), respectively. Conclusions: According to our preliminary results, RLR provides a significantly higher disease-free survival, provides a more radical therapy, reduces the incidence of recurrence and shows similar peri-operative complication rates compared to PA procedures. Minimally invasive surgery, and in particular robotic approach, should be preferred over ablative treatments to treat single small HCC.