Robotic, laparoscopic, and open liver resection for hepatocellular carcinoma: A propensity score matched analysis of perioperative outcomes

Abstract

Minimally invasive surgery may confer perioperative benefit to patients with resectable Hepatocellular Carcinoma (HCC) but published data are limited. Robotic resection for HCC has recently been introduced in our institution, and the goal of this study is to benchmark patient outcomes against open and laparoscopic surgery. A retrospective evaluation was performed of all patients undergoing liver resection for HCC in our institution between September 2012 and November 2022 using a prospectively maintained database. Data were collected relating to demographics, pre-operative staging, co-morbidities, type of resection, operative time, surgical technique, histology, length of stay, and post-operative complications. A propensity score matched analysis was performed to compare outcomes for open, laparoscopic, and robotic surgery. 106 patients were identified. 66 (62%) had open, 26 (25%) laparoscopic, and 14 (13%) had a robotic resection. Using propensity matched analysis, robotic liver resections for HCC were associated with a non-significantly lower risk of ICU admission than open surgery (0 v 21%, p = 0.16). A lower risk of conversion to open than laparoscopic surgery was seen within the unmatched cohort (0 v 23%, p = 0.07), albeit there was a significantly longer median operative times than open or laparoscopic resection (285 min v 192 and 147 respectively, p<0.001). Our data show that robotic hepatectomy is a safe alternative to open and laparoscopic resection for HCC in terms of perioperative outcomes despite increased operative times. Longer-term data will be needed to confirm the oncological safety of this approach.