Robotic liver resection for HCC reduced length of hospital stay, ICU admissions
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Robotic liver resection for hepatocellular carcinoma yielded better perioperative tolerability and may be a safe and effective alternative to open liver resection, according to research published in JAMA Surgery.
“Open hepatectomies may still be preferred in certain cases as an oncologically adequate procedure [for HCC]. Another minimally invasive approach to hepatectomy is robotic liver resection (RLR), which may also reduce the risk of conversion to open liver resection (OLR) during complex hepatectomies,” Fabrizio Di Benedetto, MD, PhD, of the hepato-pancreato-biliary surgery and liver transplantation unit at the University of Modena and Reggio Emilia in Italy, and colleagues wrote. “Despite these technical advantages, long-term oncologic outcomes of robotic surgery remain a hotly debated topic in surgical oncology because sparse data have been published thus far.”
In a retrospective analysis of data from four European and U.S. academic institutions, Di Benedetto and colleagues reviewed long- and short-term outcomes of 398 patients with HCC who underwent RLR (n = 158) or OLR (n = 240) between January 2010 and September 2020. Outcomes of interest included safety and feasibility of RLR compared with outcomes from a European validation cohort of patients who underwent OLR.
Propensity score matching yielded a comparison cohort of 106 patients in the RLR group and 106 patients in the OLR group.
According to study results, patients in the RLR group experienced a longer median operative time (295 minutes vs. 200 minutes) but shorter length of hospital stay (median, 4 days vs. 10 days) and fewer ICU admissions (7 vs. 21). Researchers also reported fewer incidences of post-hepatectomy failure in the RLR group (7.55 vs. 28.3%).
Both groups had similar 90-day overall survival rates after surgery (RLR = 99.1%; 95% CI, 93.5-99.9 vs. OLR = 97.1%; 95% CI, 91.3-99.1) and cumulative incidence tumor recurrence-related death (RLR = 8.8%; 95% CI, 3.1-18.3 vs. OLR = 10.2%; 95% CI, 4.9-17.7).
Estimated 24-month overall survival was 86.9% (95% CI, 74.7-93.5) in the RLR group and 83.8% (95% CI, 74.4-90) in the OLR group.
“The findings of this cohort study suggest that RLR confers significant advantages over OLR in patients with HCC in expert centers, with reasonable safety also at the beginning of the learning curve,” Di Benedetto and colleagues concluded. “In particular, RLR may reduce morbidity, expanding the potential number of patients able to receive treatment from which they are currently excluded because of the risk of liver decompensation.”
They added, “This study represents the largest Western experience to date of full RLR for HCC vs OLR.”
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