Background: Liver resection is the standard treatment for resectable hepatocellular carcinoma (HCC). The advent of robotic surgery has extended its application in liver surgery, reducing post-operative complications without compromising oncological safety. This study is a retrospective series with the aim of analyzing the preoperative patient’s and tumor’s characteristics and evaluating intraoperative and post-operative data in terms of hospital stay, complications, and oncological radicality. Methods: Data were collected from a multicenter retrospective database that includes 1070 consecutive robotic liver resections (RLRs) performed in nine European hospital centers from 2011 to 2023. Of the entire series, 343 liver resections were performed for HCC. Results: A total of 247 patients (72.3%) had mono-focal lesions. Major hepatectomies and anatomical resections have been perfomed in 87% and 55% of patients, respectively. All 17 conversions (4.95%) were to the open approach. The operative mean time was 239.56 min and the estimated blood loss was 229.45 mL. The overall post-operative complication rate was 22.74%, but severe complications occurred in 4.08% of patients and one of them (0.29%) was reoperated on. The mean hospital stay was 5.82 days with a mean ICU stay of 0.9 days. Twenty-six resections (7.6%) were R1 parenchymal. Forty-six patients (4.08%) were readmitted to the hospital within 90 days after discharge and seventy-eight patients (22.74%) had disease recurrence. Total deaths included 36 (10.5%) patients with a 90-day mortality of 0.9%. Conclusions: Robotic liver resection for HCC is feasible and safe when performed in experienced centers by surgeons who have completed the learning curve.
背景：肝切除术是可切除肝细胞癌（HCC）的标准治疗方法。机器人手术的出现扩展了其在肝脏外科的应用，在不影响肿瘤学安全性的前提下减少了术后并发症。本研究是一项回顾性系列研究，旨在分析患者的术前特征及肿瘤特性，并评估住院时间、并发症及肿瘤根治性等术中与术后数据。 方法：数据来源于一项多中心回顾性数据库，该数据库收录了2011年至2023年间欧洲九家医院中心连续完成的1070例机器人肝切除术（RLR）。其中，343例肝切除术针对HCC进行。 结果：共247例患者（72.3%）为单发病灶。主要肝切除术和解剖性切除术分别占87%和55%。所有17例中转手术（4.95%）均转为开腹手术。平均手术时间为239.56分钟，估计失血量为229.45毫升。总体术后并发症发生率为22.74%，但严重并发症仅见于4.08%的患者，其中1例（0.29%）接受了再次手术。平均住院时间为5.82天，平均重症监护室停留时间为0.9天。26例（7.6%）切除标本达到R1肝实质切缘。46例患者（4.08%）在出院后90天内再次入院，78例患者（22.74%）出现疾病复发。总死亡病例为36例（10.5%），其中90天死亡率为0.9%。 结论：在经验丰富的医疗中心，由已完成学习曲线的外科医生实施机器人肝切除术治疗HCC是可行且安全的。
Robotic Liver Resection for Hepatocellular Carcinoma: A Multicenter Case Series
肿瘤(癌症)患者之家