Recurrence and survival after robotic vs laparoscopic liver resection in very-early to early-stage (BCLC 0-A) hepatocellular carcinoma.

Background: Robotic (RLR) and laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) provide similar short-term outcomes, but data focused on recurrence and survival are still lacking. We hypothesized non-inferior oncologic results of RLR compared to LLR for HCC of stage BCLC 0-A.
Methods: RLRs and LLRs on patients with HCC of stage BCLC 0-A and preserved liver function (Child A or B if cirrhosis) were retrospectively reviewed. Propensity score matching (PSM) was used to mitigate selection bias. The primary endpoints were recurrence-free (RFS) and overall survival (OS); secondary endpoints were incidence, pattern, and treatment of recurrences.
Results: After 1:1 PSM, two groups (RLR = 68; LLR = 68) of patients with similar characteristics, liver function and HCC features were obtained: median age 71-years, males 73.5%, underlying cirrhosis 91.2% (Child A, 96.8%, MELD ≤ 9, 96.0%), portal hypertension 22.1%, single-HCC 90.4%. Two- and 5-year RFS were 78.0 vs 59.0% and 54.0 vs 53.0% (p = 0.107), while OS was 97.0 vs 90.0% and 87.0 vs 90.0% (p = 0.951) for RLR vs LLR, respectively. Incidence of HCC recurrence was similar (35.3 vs 39.7%; p = 0.723). Recurrences developed mostly within the liver (29.4 vs 30.9%; p = 1.000) and within 2 years after hepatectomy (19.1 vs 32.4%, p = 0.116) in RLR vs LLRs. Curative-intent treatment of recurrences did not differ (liver transplantation 19.6%, redo-resection 15.7%, locoregional treatments 52.9%) except for a tendency toward more redo-resections for recurrences after RLR.
Conclusions: Oncologic outcomes of RLR were not inferior to those of LLR in selected HCC patients of stage BCLC 0-A with underlying cirrhosis. Both techniques guaranteed similar salvageability in case of HCC recurrence.
Competing Interests: Declarations. Disclosures: Drs. Lorenzo Bernardi, Emanuele Balzano, Raffaello Roesel, Annamaria Senatore, Daniele Pezzati, Gabriele Catalano, Maria Luisa Garo, Giovanni Tincani, Pietro Majno-Hurst, Davide Ghinolfi, and Alessandra Cristaudi have no conflicts of interest or financial ties to disclose. Ethical approval: This study was conducted in accordance with the Declaration of Helsinki. The study was approved by the regional ethical committees of the institutions participating in the study. Informed consent: Patients provided informed consent to participate to the study at first referral at Pisa University Hospital as per institutional policy. Patients in Regional Hospital of Lugano were informed of the ongoing study and received a non-objection letter from the institution. Written informed consent for participants from Lugano was not required in accordance with local guidelines.
(© 2025. The Author(s).)