Robotic versus Laparoscopic Liver Resection for Hepatocellular Carcinoma: Short-term and Long-term Oncologic Outcomes

Abstract

Introduction: There is growing evidence supporting the feasibility and safety of robotic liver resection; however, data on long-term oncologic outcomes in patients with liver malignancy are still lacking. In this study, we performed a matched comparison of short- and long-term oncologic outcomes between robotic and laparoscopic liver resection in patients with hepatocellular carcinoma (HCC). Method: We retrospectively reviewed all cases of laparoscopic and robotic liver resection for HCC performed at our institute from 2006 to 2016. A total of 169 patients who underwent laparoscopic liver resection and 40 patients who underwent robotic liver resection were included. A multivariable logistic model based on factors related to the patient, tumor, and surgical procedure was then used to estimate propensity scores. Survival data were obtained using the Kaplan–Meier method. Result: The two groups did not differ significantly with respect to perioperative outcomes, measured in terms of estimated blood loss, transfusion rate, conversion rate to open surgery, resection margins, perioperative complication rates, and length of hospital stay. All resections were R0 resections, and no perioperative deaths were noted. The operation time was notably longer in the robotic group than in the laparoscopic group (median 488 vs. 306 min; P < 0.001). However, it was noted that more major resections were performed with the robotic approach than with the laparoscopic approach (87.5% vs. 23.1%; P < 0.001). After propensity score matching, the robotic group (n = 27) showed similar 1-, 3-, and 5-year disease-free (P = 0.696) and overall survival rates (P = 0.869) to those of the laparoscopic group (n = 27). Conclusion: Robotic liver resection for HCC produced similar oncologic outcomes in terms of R0 resection, 5-year disease-free survival, and overall survival rates, and allowed for more major liver resections to be performed as compared with laparoscopic liver resection.