Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital; Institute of Hepatobiliary Surgery of Chinese PLA; Key Laboratory of Digital Hepatobiliary Surgery, PLA, Beijing.
The First Clinical Medical School, Lanzhou University.
Int J Surg. 2024 Feb 1;110(2):660-667. doi: 10.1097/JS9.0000000000000873.
Robotic hepatectomy (RH) is currently widely accepted and it is associated with some benefits when compared to open hepatectomy (OH). However, whether such benefits can still be achieved for patients with large hepatocellular carcinoma (HCC) remain unclear. This study aimed to evaluate the short-term and long-term outcomes of patients undergoing RH or OH.
Perioperative and survival data from patients with large HCC who underwent RH or OH between January 2010 and December 2020 were collected from eight centres. Propensity score matching (PSM) was performed to minimise potential biases.
Using predefined inclusion criteria, 797 patients who underwent OH and 309 patients who underwent RH were enroled in this study. After PSM, 280 patients in the robotic group had shorter operative time (median 181 vs. 201 min, P <0.001), lower estimated blood loss (median 200 vs. 400 ml, P <0.001), and shorter postoperative length of stay (median 6 vs. 9 days, P <0.001) than 465 patients in the open group. There were no significant differences between the two groups in overall survival and recurrence-free survival. Cox analysis showed AFP greater than 400 ng/ml, tumour size greater than 10 cm, and microvascular invasion were independent risk factors for overall survival and recurrence-free survival. After PSM, subgroup analysis showed that patients with a huge HCC (diameter >10 cm) who underwent RH had significantly lower estimated blood loss (median 200.0 vs. 500.0 min, P <0.001), and shorter length of stay (median 7 vs. 10 days, P <0.001) than those who underwent OH.
Safety and feasibility of RH and OH for patients with large HCC were comparable. RH resulted in similar long-term survival outcomes as OH.
与开腹肝切除术（OH）相比，机器人肝切除术（RH）目前被广泛接受，并具有一些优势。然而，对于大肝癌（HCC）患者，这些优势是否仍然能够实现尚不清楚。本研究旨在评估接受 RH 或 OH 的患者的短期和长期结果。
从 2010 年 1 月至 2020 年 12 月期间在 8 个中心接受 RH 或 OH 的大 HCC 患者的围手术期和生存数据被收集。采用倾向评分匹配（PSM）以尽量减少潜在偏倚。
根据预先确定的纳入标准，OH 组纳入 797 例患者，RH 组纳入 309 例患者。PSM 后，机器人组 280 例患者的手术时间更短（中位数 181 比 201 分钟，P <0.001），估计失血量更少（中位数 200 比 400 毫升，P <0.001），术后住院时间更短（中位数 6 比 9 天，P <0.001）。两组患者的总生存和无复发生存无显著差异。Cox 分析显示，AFP 大于 400ng/ml、肿瘤直径大于 10cm 和微血管侵犯是总生存和无复发生存的独立危险因素。PSM 后，亚组分析显示，直径大于 10cm 的巨大 HCC 患者接受 RH 的估计失血量明显较少（中位数 200.0 比 500.0 分钟，P <0.001），住院时间更短（中位数 7 比 10 天，P <0.001）。
RH 和 OH 治疗大 HCC 的安全性和可行性相当。RH 与 OH 相比具有相似的长期生存结果。
