Objective To investigate the clinical efficacy of robotic‑assisted liver resection versus laparoscopic liver resection for the treatment of hepatocellular carcinoma (HCC).
Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 202 patients with HCC who were admitted to The First Affiliated Hospital of Harbin Medical University from October 2020 to October 2024 were collected. There were 155 males and 47 females, aged 59(51,65) years. Of 202 patients, 72 cases undergoing robotic‑assisted liver resection were allocated into the robotic group, 130 cases undergoing laparoscopic liver resection were allocated into the laparoscopic group. Observation indicators: (1) propensity score matching and comparison of clinicopathological characteristics of patients between the two groups after matching; (2) surgical situations; (3) postoperative situations; (4) survival analysis; (5) analysis of prognostic factors. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann‑Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann‑Whitney U test. The Kaplan‑Meier method was used to draw survival curves, and the Log‑rank test was used for survival analysis. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model. Propensity score matching was performed with the 1∶1 nearest neighbor matching method with a caliper value of 0.02.
Results (1) Propensity score matching and comparison of clinicopathological characteristics of patients between the two groups after matching: of the 202 patients, 114 cases were successfully matched, with 57 cases in each group. After propensity score matching, the elimination of tumor number, China Liver Cancer Staging (CNLC), and surgical difficulty grading confounding bias ensured comparability. (2) Surgical situations: after propensity score matching, the operation time was 2.5 (1.8, 3.6) hours for the robotic group and 4.5(3.3,6.3) hours for the laparoscopic group, the volume of intraoperative blood loss was 90.0 (50.0, 100.0) mL for the robotic group and 100.0 (50.0, 200.0) mL for the laparoscopic group, cases with intraoperative transfusion numbered 4 for the robotic group and 17 for the laparoscopic group, cases with conversion to laparotomy numbered 0 for the robotic group and 6 for the laparoscopic group, showing significant differences in the above indicators between the two groups (Z=-5.30, -2.04, χ²=9.86, 4.40, P<0.05). (3) Postoperative situations: after propensity score matching, the postoperative albumin level was (36.2±4.5) g/L for the robotic group and (34.4±4.1) g/L for the laparoscopic group, postoperative aspartate aminotransferase level was 113.3 (82.6, 175.0) U/L for the robotic group and 219.8 (101.8, 378.2) U/L for the laparoscopic group, postoperative prothrombin time was 12.6 (11.9, 13.6) seconds for the robotic group and 13.4 (12.5, 14.5) seconds for the laparoscopic group, the lower 24‑hour numeric rating scale (NRS) pain score was 2.0 (2.0, 3.0) for the robotic group and 3.0 (2.0, 3.0) for the laparoscopic group, cases with severe complications numbered 1 for the robotic group and 8 for the laparoscopic group, cases with textbook outcomes in liver surgery (TOLS) numbered 56 for the robotic group and 49 for the laparoscopic group, cases with pleural effusion numbered 3 for the robotic group and 12 for the laparoscopic group, cases with pneumonia numbered 2 for the robotic group and 12 for the laparoscopic group, showing significant differences in the above indicators between the two groups (t=-2.18, Z=-3.08, -2.80, -3.04, χ²=4.34, 4.34, 6.22, 8.14, P<0.05). (4) Survival analysis: after propensity score matching, the median follow‑up time was 31 (21, 46) months for patients. The 1‑ and 3‑year overall survival rates were 94.7% and 87.7% in the robotic group, and 93.0% and 86.0% in the laparoscopic group, showing no significant difference between them (χ²=0.24, P>0.05). (5) Analysis of prognostic factors: after propensity score matching, results of multivariate analysis showed that tumor diameter and CNLC showed no statistically significant association with prognosis of patients (hazard ratio=0.45, 1.76, 95% confidence interval as 0.10-2.10, 0.38-8.26, P>0.05).
Conclusions Both robotic‑assisted and laparoscopic liver resection are safe and feasible for the treatment of HCC. Compared with laparoscopic liver resection, robotic‑assisted liver resection offers shorter operation time and postoperative prothrombin time, less volume of intraoperative blood loss, higher postoperative albumin, lower postoperative aspartate aminotransferase and 24‑hour NRS pain score, lower ratios of intraoperative transfusion, conversion to laparotomy, postoperative severe complications, postoperative pleural effusion, postoperative pneumonia, and a higher ratio of TOLS.
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