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Background and Objectives <p>Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has been linked to several advantages compared to open approach, but the actual benefit of robotic liver resection (RLR) over LLR in HCC needs further investigation.</p> Methods <p>We performed a multicentric propensity-score matched (PSM) analysis comparing perioperative and oncologic outcomes of LLR vs. RLR for HCC. The PSM model was estimated using a multivariable logistic regression, with type of surgery as dependent variable and age, BMI, clinically-significant portal hypertension, αFP, size of principal lesion, number of nodules and Kawaguchi difficulty score as covariates. Overall (OS) and recurrence-free (RFS) survivals were estimated using the Kaplan–Meier method.</p> Results <p>Six-hundred-forty-seven HCC patients from 12 IGoMILS registry centers treated by LLR (553 patients) or RLR (94 patients) were included. After PSM, RLR resulted in wider surgical margins (median: 10 vs 5&#xa0;mm; <i>p</i> = 0.002) with higher prevalence of R0 resection (98.9 vs 93.1%; <i>p</i> = 0.037), lower conversion rate (2.1 vs. 8.5%; <i>p</i> = 0.039) and shorter hospital stay (median: 4 vs 5&#xa0;days; <i>p</i> = 0.025), with no significant difference in postoperative complication rate. We observed similar OS among RLR and LLR cohorts [5-y OS: 68.7 vs 65.0%; univariable HR = 0.95 (95% CI: 0.60–1.49); <i>p</i> = 0.82], with significantly better RFS in RLR cohort [5-y RFS: 46.8 vs 24.0%; univariable HR = 0.71 (95% CI: 0.52–0.98); <i>p</i> = 0.04].</p> Conclusions <p>Perioperative outcomes were significantly better in the RLR cohort, with a lower conversion rate and shorter hospital stay, although the latter may be influenced by the multi-institutional study design. Notably, we observed wider resection margins in the RLR group, which were associated with significantly improved RFS.</p> Graphical Abstract <p></p>

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Robotic vs laparoscopic resection for hepatocellular carcinoma: multicentric propensity-score matched analysis of surgical and oncologic outcomes in 647 patients

  • 期刊论文

  • 发表日期：

    2025年7月20日

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  • Stefano Di Sandro,
  • Leonardo Centonze,
  • Francesca Ratti,
  • Nadia Russolillo,
  • Simone Conci,
  • Enrico Gringeri,
  • Francesco Ardito,
  • Marco Colasanti,
  • Carlo Sposito,
  • Riccardo De Carlis,
  • Mario Giuffrida,
  • Pasquale Bonsignore,
  • Matteo Zanello,
  • Samuele Frassoni,
  • Roberta Odorizzi,
  • Vincenzo Bagnardi,
  • Elio Jovine,
  • Salvatore Gruttadauria,
  • Maurizio Iaria,
  • Andrea Lauterio,
  • Vincenzo Mazzaferro,
  • Giuseppe Maria Ettorre,
  • Felice Giuliante,
  • Umberto Cillo,
  • Andrea Ruzzenente,
  • Alessandro Ferrero,
  • Luca Aldrighetti,
  • Fabrizio Di Benedetto,
  • Giorgio Ercolani,
  • Matteo Ravaioli,
  • Andrea Belli,
  • Matteo Barabino,
  • Alberto Brolese,
  • Giovanni Vennarecci,
  • Antonio Frena,
  • Giorgio Rossi,
  • Riccardo Memeo,
  • Ugo Boggi,
  • Giacomo Batignani,
  • Mohammed Abu Hilal,
  • Gian Luca Grazi,
  • Leonardo Vincenti,
  • Guido Griseri,
  • Marco Massani,
  • Luca Morelli,
  • Fulvio Calise,
  • Raffaele Romito,
  • Fausto Zamboni,
  • Guido Torzilli,
  • Marco Filauro,
  • Stefano Berti,
  • Marco Vivarelli,
  • Giuseppe Navarra,
  • Giuseppe Tisone,
  • Amedeo Carraro,
  • Andrea Coratti,
  • Graziano Ceccarelli,
  • Christian Cotsoglou,
  • Daniela Caracciolo,
  • Giulio Belli,
  • Pietro Mezzatesta,
  • Adelmo Antonucci,
  • Luigi Veneroni,
  • Dario Lorenzin,
  • Albero Patriti,
  • Michele Colledan,
  • Amilcare Parisi,
  • Francesco Coratti,
  • Anna Lucia Segreto,
  • Silvio Guerriero,
  • Marco Spada,
  • Stefano Mancini,
  • Marcello Spampinato,
  • Antonio Floridi,
  • Giovanni Sgroi,
  • Fabrizio Romano,
  • Paola Tarchi,
  • Dario Ribero,
  • Pietro Maida,
  • Luigi Boni,
  • Andrea Percivale,
  • Umberto Montin

摘要

Background and Objectives

Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has been linked to several advantages compared to open approach, but the actual benefit of robotic liver resection (RLR) over LLR in HCC needs further investigation.

Methods

We performed a multicentric propensity-score matched (PSM) analysis comparing perioperative and oncologic outcomes of LLR vs. RLR for HCC. The PSM model was estimated using a multivariable logistic regression, with type of surgery as dependent variable and age, BMI, clinically-significant portal hypertension, αFP, size of principal lesion, number of nodules and Kawaguchi difficulty score as covariates. Overall (OS) and recurrence-free (RFS) survivals were estimated using the Kaplan–Meier method.

Results

Six-hundred-forty-seven HCC patients from 12 IGoMILS registry centers treated by LLR (553 patients) or RLR (94 patients) were included. After PSM, RLR resulted in wider surgical margins (median: 10 vs 5 mm; p = 0.002) with higher prevalence of R0 resection (98.9 vs 93.1%; p = 0.037), lower conversion rate (2.1 vs. 8.5%; p = 0.039) and shorter hospital stay (median: 4 vs 5 days; p = 0.025), with no significant difference in postoperative complication rate. We observed similar OS among RLR and LLR cohorts [5-y OS: 68.7 vs 65.0%; univariable HR = 0.95 (95% CI: 0.60–1.49); p = 0.82], with significantly better RFS in RLR cohort [5-y RFS: 46.8 vs 24.0%; univariable HR = 0.71 (95% CI: 0.52–0.98); p = 0.04].

Conclusions

Perioperative outcomes were significantly better in the RLR cohort, with a lower conversion rate and shorter hospital stay, although the latter may be influenced by the multi-institutional study design. Notably, we observed wider resection margins in the RLR group, which were associated with significantly improved RFS.

Graphical Abstract