Editor’s Note: Primary liver cancer (PLC) is one of the most common cancers worldwide and a leading cause of cancer-related deaths, with hepatocellular carcinoma (HCC) accounting for about 85% of all PLC cases. Despite continuous advancements in medical technology, radical surgical resection of the primary tumor remains a key component of HCC treatment. Robotic liver resection (RLR) is a relatively new technique that combines the advantages of traditional surgery with the precision and flexibility of robotic surgical systems. However, it remains unclear whether RLR is superior to traditional surgery in clinical practice.
Recently, Professor Zhenyu Zhu’s team from the Fifth Medical Center of the Chinese PLA General Hospital published a retrospective cohort study in the journal Hepatology International. The study evaluated the potential impact of RLR on the long-term prognosis of HCC patients and assessed the learning curve of this technique for HCC treatment.
Study Background
Recent high-quality retrospective and prospective studies have confirmed the safety and efficacy of RLR in both short-term and long-term outcomes, suggesting it may be superior to open liver resection (OLR). However, existing high-quality retrospective studies comparing RLR with laparoscopic liver resection (LLR) have mainly focused on short-term outcomes, with a significant lack of evidence on long-term outcomes.
Study Methods
The study included patients who underwent RLR and LLR for HCC resection between July 2016 and July 2021. Researchers used propensity score matching (PSM) to match patients in the RLR and LLR groups in a 1:3 ratio. They comprehensively collected and analyzed data on patient outcomes and safety, and assessed the learning curve of RLR.
Study Results
Over a five-year period, 529 patients were included, with 107 patients (85 males and 22 females) in the RLR group and 422 patients (348 males and 74 females) in the OLR group. In the initial analysis, researchers observed a significantly lower ASA score in patients undergoing RLR (P=0.03). Additionally, before PSM, there was a significant difference in IWATE standard difficulty between the RLR and OLR groups (P=0.04). Compared to the LLR group, patients in the RLR group had significantly lower ECOG PS scores (P=0.01), and the CPT status was significantly higher in the RLR group (P=0.01).
After PSM, 341 patients were included, with 97 in the RLR group and 244 in the LLR group. The RLR group had a significantly longer operation time [median (IQR), 210 (152.0298.0) min vs. 183.5 (132.3263.5) min; P=0.04], with no significant differences in other perioperative and short-term postoperative outcomes.
The overall survival (OS) was similar between the two groups (P=0.43), but the recurrence-free survival (RFS) was longer in the RLR group (median 65 months vs. 56 months, P=0.006). The estimated 5-year OS rates for the RLR and LLR groups were 74.8% (95% CI: 65.4%~85.6%) and 80.7% (95% CI: 74.0%~88.1%), respectively. The estimated 5-year RFS rates for the RLR and LLR groups were 58.6% (95% CI: 48.6%~70.6%) and 38.3% (95% CI: 26.4%55.9%), respectively. In multivariate Cox regression analysis, RLR (HR: 0.586, 95% CI: 0.3930.874, P=0.008) was identified as an independent predictor for reduced recurrence rate and improved RFS.
The learning curve for RLR showed that proficiency was generally achieved after about 11 cases.
Study Conclusion
The study results confirm the feasibility and safety of RLR as a surgical treatment for HCC. RLR improved RFS while achieving comparable OS to LLR. This study emphasizes the oncological feasibility of RLR in treating HCC and lays the foundation for future randomized controlled trials.
Reference: Li, H., Meng, L., Yu, S. et al. Efficacy and safety of robotic versus laparoscopic liver resection for hepatocellular carcinoma: a propensity score-matched retrospective cohort study. Hepatol Int (2024). https://doi.org/10.1007/s12072-024-10658-6
