Robotic versus open hepatectomy for large(≥ 5 cm) hepatocellular carcinoma: A large volume center, propensity score matched study

Abstract

BACKGROUND: Robotic hepatectomy is widely used to treat liver tumors. However, there are limited studies comparing robotic hepatectomy with conventional open hepatectomy for large (≥ 5 cm) hepatocellular carcinoma. This study aims to evaluate the perioperative and long-term outcomes of patients with large and huge hepatocellular carcinoma undergoing robotic or open hepatectomy. METHODS: This retrospective study included patients with large hepatocellular carcinoma who underwent robotic hepatectomy or open hepatectomy by the same surgical team at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, from January 2021 to January 2024. Propensity score matching (PSM) was used to minimize potential bias. RESULTS: According to the predetermined inclusion criteria, this study included 96 open hepatectomy(OH) patients and 23 robotic hepatectomy (RH) patients. After PSM, two homogeneous groups (RH and OH, n = 23 each) were created. The RH group had less blood loss (median 100 ml vs. 300ml, P = 0.008) and a lower incidence of postoperative pulmonary complications (8.7% vs. 39.1%, P = 0.016) compared to the OH group. There were no statistically significant differences in overall survival (OS) and disease-free survival (DFS) between the two groups. CONCLUSION: For patients with large(≥ 5 cm) hepatocellular carcinoma, robotic hepatectomy provides a safe, feasible and less invasive approach for treatment.