Outcomes of robotic‐assisted liver surgery versus laparoscopic liver surgery for treatment of stage I hepatocellular carcinoma

Abstract

Background This article investigated whether robotic‐assisted liver surgery versus laparoscopic liver surgical treatment of hepatocellular carcinoma (HCC) has similar or different short‐ and long‐term clinical outcomes. Methods A total of 3049 patients from the National Cancer Database who received minimally invasive surgery (ie, robotic or laparoscopic surgery) for stage I HCC cancers between 2010 to 2015, of which 123 had robotic and 2926 had laparoscopic surgeries performed, were identified. Logistic regression was applied to evaluate short‐term outcomes. Cox proportional hazards models were applied to estimate all‐cause mortality at 1‐year, 3‐years, and 5‐years after surgery, adjusting for potential confounders. Propensity score‐matched analyses were conducted to compare long‐term outcomes between robotic and laparoscopic surgeries. Results Robotic surgery was associated with improved overall survival, with 1‐, 3‐, and 5‐year survival rates (SRs) of 0.92, 0.75, and 0.63 compared with laparoscopic surgery SRs of 0.86, 0.60, and 0.45, respectively (P value <.01). Multivariate analyses showed that robotic compared with laparoscopic surgery had significantly lower 5‐year total mortality (hazard ratio [HR], 0.64 and 95% confidence interval [CI], 0.45%‐0.93% for intent‐to‐treat; HR, 0.62 and 95% CI, 0.42%‐0.91% for end‐treatment analyses). Similar results were found in propensity score matched analyses; robotic surgery was associated with improved overall survival compared with laparoscopic surgery (HR, 0.64 and 95% CI, 0.43%‐0.96% for intent‐to‐treat; HR, 0.59 and 95% CI, 0.39%‐0.90% for end‐treatment). Conclusions Robotic surgery is not inferior to laparoscopic surgery in treating early‐stage HCC and may be associated with improved long‐term survival.

The Role of ICG in Robot-Assisted Liver Resections

“…Interestingly, they experienced a wash out of ICG if injected more than 24 h before surgery, and therefore favor 24 h between injection and surgery [ 44 ]. This is contrary to the initial reports by Ishizawa et al and others who warrant application times for up to 14 days before the surgery [ 6 , 11 , 19 , 20 , 46 ]. Kobayashi et al further proposed an additional injection one day before the surgery if the initial application was too long before the surgery [ 48 ].…”

“…However, long procedure times are often considered a drawback of robotic surgery [ 1 , 2 , 3 , 26 , 28 , 30 , 31 , 32 ]. They expose the patients to a different level of stress, i.e., from an anesthesiological point of view, causing further morbidity [ 6 , 33 , 34 ]. Overall, procedure times reported herein were comparable to the times reported by other studies [ 24 , 32 , 35 ].…”

“…Very few intra- and post-operative complications were noted in both cohorts. This may be a reflection of the more precise and less harmful surgical approach, which improves the short-term outcome and quality of life [ 1 , 6 , 7 , 12 , 35 , 39 , 40 ].…”

“…The average sizes of the tumors were 27.1 ± 25.0 mm and 47.6 ± 35.2 mm, respectively. Li et al reported safe RALS in patients with tumors of a size of 5.6 cm, while Duong et al only included tumors < 50 mm in diameter, both achieving good surgical and oncological results [ 6 , 42 ]. The distances to the resection margins were 5.8 ± 10.9 and 10.2 ± 13.4 mm, respectively, which is in line with the reports of others.…”

“…Presently, robotic procedures, including hepatic procedures, are being increasingly performed [ 1 , 2 , 3 ]. The advantages of robotic surgery are well known, and robotic liver surgery has been proven to be safe [ 4 , 5 , 6 ]. Despite advantages such as steady and clear 3D visualization, superior ergonomics, and improved dexterity, a major limitation of robotic surgery is its lack of haptic feedback, so much so that the surgeon purely relies on the visual aspects [ 1 , 7 , 8 ].…”