Robotic Liver Resection for Hepatocellular Carcinoma Offers Oncologic Efficacy, Safety

Robotic liver resection offers advantages over open liver resection in patients with hepatocellular carcinoma in expert centers, according to study findings published online ahead of print in JAMA Surgery.

“In particular, robotic liver resection 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,” wrote corresponding authors Fabrizio Di Benedetto, MD, and Stefano Di Sandro, MD, of the University of Modena and Reggio Emilia, Modena, Italy, and coauthors.

The cohort study spanned 393 patients and included a propensity-score matched comparison of 106 patients who underwent robotic liver resection and 106 who underwent open liver resection at Western high-volume centers.

Patients who underwent robotic liver resection had a longer operative time but a shorter hospital stay (median 4 days vs 10 days with open liver resection) and a lower number of intensive care unit (ICU) admissions (7 vs 21), according to the study. Furthermore, the incidence of posthepatectomy liver failure was 7.5% in the robotic liver resection group compared with 28.3% in the open liver resection group.

The 90-day overall survival rate was 99.1% for patients who underwent robotic liver resection and 97.1% for those who underwent open liver resection, the study found. Also comparable between the patient groups was the cumulative incidence of death related to tumor recurrence: 8.8% among those who underwent robotic liver resection and 10.2% among those who underwent open liver resection.

“It is well known that one of the major criticisms to the use of robotic technology in surgery is cost. Unfortunately, we could not run a cost comparison and cost-effectiveness analysis because of the different reimbursement systems and uneven costs of each tool across countries,” researchers wrote. “However, intuitively, a median difference of 6 days of hospitalization represents a major saving for any hospital, as well as a 93.4% vs 80.2% rate of robotic liver resection and open liver resection patients, respectively, not requiring intensive care unit admission.”

—Jolynn Tumolo

Reference

Di Benedetto F, Magistri P, Di Sandro S, et al. Safety and efficacy of robotic vs open liver resection for hepatocellular carcinoma. JAMA Surg. Published online November 23, 2022. doi:10.1001/jamasurg.2022.5697