Wang Yunchuan, Lu Shiliu, Tan Xuelin, Xie Shengjie, Liang Guozhi, Liang Haifeng, Guo Jixu, Yuan Guandou, Yu Shuiping, He Songqing
Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, Guangxi, China.
Surg Endosc. 2025 Mar;39(3):1902-1914. doi: 10.1007/s00464-024-11521-3. Epub 2025 Jan 23.
Both laparoscopic hepatectomy (LH) and robotic hepatectomy (RH) have been performed for tumors in nearly all liver segments. However, few studies have compared the outcomes of patients who underwent open hepatectomy (OH), LH and RH for the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A HCC in S7/8.
The clinical data of patients who underwent S7/8 resection for the treatment of BCLC stage 0-A HCC in the First Affiliated Hospital of Guangxi Medical University from July 2017 to July 2023 were retrospectively collected. To minimize selection bias, propensity score matching (PSM) analysis was performed using American Society of Anesthesiology (ASA), tumor size, body mass index (BMI), alpha-fetoprotein (AFP), tumor location, age, number of tumors, platelet (PLT), and Viral hepatitis.
A total of 401 patients met the study criteria. After PSM, 61 OH (28.6%), 74 LH (34.8%), and 78 RH (36.6%) were included. RH group had the least blood loss among the three groups (OH, 300 vs. LH, 215 vs. RH, 100 mL, P < 0.001). Conversion rate was significantly lower in RH group compared to LH group [LH, 10 (13.5%) vs. RH, 1 (1.3%), P = 0.003]. Although minimally invasive group (RH + LH) took slightly longer operative time (OH, 233 vs. LH, 255.5 vs. RH, 257 min, P = 0.068), there was no statistical difference. The minimally invasive group had fewer postoperative hospital stay (OH, 8 vs. LH, 6 vs. RH, 6 days, P < 0.001). The minimally invasive group had lower rates of surgical complications (OH, 37.7% vs. LH, 20.3% vs. RH, 11.5%). However, there were no statistically significant variations observed in the disease-free survival or overall survival rates among the three groups.
RH showed advantage over the OH and LH in short-term outcomes, and non-inferiority in survival outcomes for the treatment of BCLC stage 0-A HCC patients.
腹腔镜肝切除术（LH）和机器人肝切除术（RH）已应用于几乎所有肝段的肿瘤切除。然而，很少有研究比较接受开腹肝切除术（OH）、LH和RH治疗巴塞罗那临床肝癌（BCLC）0-A期位于S7/8段肝细胞癌（HCC）患者的治疗效果。
回顾性收集2017年7月至2023年7月在广西医科大学第一附属医院接受S7/8段切除治疗BCLC 0-A期HCC患者的临床资料。为尽量减少选择偏倚，采用美国麻醉医师协会（ASA）、肿瘤大小、体重指数（BMI）、甲胎蛋白（AFP）、肿瘤位置、年龄、肿瘤数量、血小板（PLT）和病毒性肝炎进行倾向评分匹配（PSM）分析。
共有401例患者符合研究标准。PSM后，纳入61例OH患者（28.6%）、74例LH患者（34.8%）和78例RH患者（36.6%）。RH组在三组中失血量最少（OH组300 mL vs. LH组215 mL vs. RH组100 mL，P < 0.001）。RH组的中转率显著低于LH组[LH组10例（13.5%）vs. RH组1例（1.3%），P = 0.003]。虽然微创组（RH + LH）手术时间略长（OH组233分钟vs. LH组255.5分钟vs. RH组257分钟，P = 0.068），但无统计学差异。微创组术后住院时间更短（OH组8天vs. LH组6天vs. RH组6天，P < 0.001）。微创组手术并发症发生率更低（OH组37.7% vs. LH组20.3% vs. RH组11.5%）。然而，三组间无病生存率或总生存率无统计学显著差异。
对于治疗BCLC 0-A期HCC患者，RH在短期疗效方面优于OH和LH，在生存结局方面不劣于OH和LH。
