Robotic liver resection safe, effective for hepatocellular carcinoma
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Robotic liver resection appeared safe and effective compared with open liver resection among patients with hepatocellular carcinoma, according to study results published in JAMA Surgery.
The findings also showed the robotic approach may reduce morbidity, potentially enabling treatment for patients who would not be able to receive it due to risk for liver decompensation, researchers concluded.
Background and methods
Data are lacking on long-term outcomes of robotic surgery among patients with HCC, according to Fabrizio Di Benedetto, MD, PhD, researcher in the hepato-pancreato-biliary surgery and liver transplantation unit at University of Modena and Reggio Emilia in Italy, and colleagues.
For this reason, researchers conducted a retrospective analysis of prospectively maintained databases from two U.S. and two European institutions that included patients with HCC who underwent robotic liver resection between Jan. 1, 2010, and Sept. 30, 2020.
Researchers used 1:1 propensity score matching to compare 106 patients who underwent robotic liver resection (median age, 66 years) with a validation cohort of 106 patients who underwent open liver resection (median age, 70 years) at a European center that did not perform robotic liver resection.
Safety, feasibility and oncologic outcomes between the two procedures served as main outcomes.
Findings
Results showed patients who underwent robotic liver resection experienced significantly longer median operative times than those who underwent open liver resection (295 minutes vs. 200 minutes; P < .001).
However, robotic liver resection resulted in significantly fewer median days in hospital (4 days vs. 10 days; P < .001) and ICU admissions (6.6% vs. 19.8%; P = .002).
In addition, researchers observed a lower incidence of post-hepatectomy liver failure among those in the robotic liver section group (7.5% vs. 28.3%; P = .001) and no cases of grade C failure.
Moreover, they found comparable 90-day OS rates between the robotic liver resection group (99.1%; 95% CI, 93.5-99.9) and the open liver resection group (97.1%; 95% CI, 91.3-99.1), and comparable rates of cumulative incidence for death associated with tumor recurrence (8.8%; 95% CI, 3.1-18.3 vs. 10.2%; 95% CI, 4.9-17.7).
Researchers reported limitations of the study, including the retrospective design and potential biases of the multicenter, nonrandomized protocol.
Implications
“This cohort study is, to our knowledge, the largest Western series of consecutive patients treated with the full robotic liver resection approach for HCC,” the researchers wrote. “The results show that robotic liver resection is associated with better perioperative tolerability than open liver resection in patients with HCC after a propensity score-matching analysis based on clinical, oncologic and technical criteria. After propensity score matching, the two populations became homogeneous on the basis of not only baseline characteristics but also surgical difficulty and preoperative risk for tumor recurrence, representing an important refinement in this kind of analysis.”
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