Robotic liver resection for hepatocellular carcinoma: a focus on anatomic resection

Abstract

Aim: Robotic liver resection (RLR) is a new platform for minimally invasive hepatobiliary surgery. Minimally invasive surgery can confer benefits to patients with hepatocellular carcinoma (HCC), which is mostly associated with underlying chronic liver disease. Despite the inherent functional merits of robotics for surgical techniques, the clinical advantages of hepatectomy are not well defined. Therefore, we reviewed the short-term and long-term surgical results of 57 HCC cases in 46 patients who underwent RLR at our institution.

Methods: We evaluated the feasibility and safety of robotic anatomic liver resection for HCC by comparing the results of the anatomic resection (AR) group (n = 23) and non-anatomic resection (NAR) group (n = 34).

Results: Overall (n = 57), the liver-specific console time was 487 min, blood loss was 194 g, and there was one open conversion (2%). Postoperative data showed acceptable hepatic functional recovery, with a major complication rate of 11% and no 90-day mortality. Compared to NAR, AR was associated with longer operative and console times, more blood loss, and worse postoperative liver function, thus reflecting the greater extent and complexity of hepatectomies for more advanced-stage tumors than NAR. Nonetheless, major complication rate, mortality rate, length of hospital stay, and R0 resection rate were comparable between groups. Long-term results were comparable to those of previously reported hepatectomies for HCC and were similar between groups.

Conclusion: RLR including AR may be a safe and feasible form of hepatectomy for select patients with HCC.

Keywords

Anatomic liver resection / Glissonian pedicle approach / hepatocellular carcinoma / laparoscopic liver resection / Laennec’s capsule / robotic liver resection

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