World journal of gastrointestinal surgery · 2025
Outcomes of robotic liver resection and intraoperative radiofrequency ablation for hepatocellular carcinoma in posterior segments VII and VIII.
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Peng Cheng-Ming, Lin Shao-Chieh, Cheng Yung-Yin, Cheng Teng-Chieh, Hsieh Ching-Lung, Hsieh Chia-Hong, Hsieh Mei-Fang, Liao Chun-Han, Liu Ming-Cheng, Liu Yi-Jui
Аннотация
BACKGROUND: Hepatocellular carcinoma (HCC) in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation (RFA). Robotic-assisted techniques may enhance safety and precision, but comparative evidence remains limited.
AIM: To compare the clinical outcomes of robotic liver resection (R-LR) and robotic intraoperative RFA (RIO-RFA) for HCC located in liver segments VII and VIII.
METHODS: We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo (n = 57) or first recurrent (n = 36). HCC who underwent R-LR or RIO-RFA between 2015 and 2024. Propensity score matching was performed to reduce selection bias. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier curves, log-rank tests, and Cox regression were used to identify prognostic factors for OS and RFS.
RESULTS: In the de novo group, OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching. In contrast, the recurrent group showed significantly improved OS and RFS with R-LR (P = 0.005 and P = 0.012, respectively). Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR, whereas carefully selected low-risk recurrent patients undergoing RIO-RFA (smaller tumors, absence of complications) achieved outcomes comparable to R-LR. Platelet count, tumor size, and postoperative complications constituted key prognostic factors.
CONCLUSION: For HCC in challenging liver segments VII and VIII, R-LR and RIO-RFA achieve comparable outcomes in de novo cases, whereas R-LR confers superior survival in recurrent disease. R-LR should be prioritized for small de novo HCCs and for recurrent disease overall; RIO-RFA may serve as an effective alternative in carefully selected low-risk recurrent patients. Tumor size, platelet count, and postoperative complications are key prognostic indicators to guide individualized treatment.
AIM: To compare the clinical outcomes of robotic liver resection (R-LR) and robotic intraoperative RFA (RIO-RFA) for HCC located in liver segments VII and VIII.
METHODS: We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo (n = 57) or first recurrent (n = 36). HCC who underwent R-LR or RIO-RFA between 2015 and 2024. Propensity score matching was performed to reduce selection bias. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier curves, log-rank tests, and Cox regression were used to identify prognostic factors for OS and RFS.
RESULTS: In the de novo group, OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching. In contrast, the recurrent group showed significantly improved OS and RFS with R-LR (P = 0.005 and P = 0.012, respectively). Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR, whereas carefully selected low-risk recurrent patients undergoing RIO-RFA (smaller tumors, absence of complications) achieved outcomes comparable to R-LR. Platelet count, tumor size, and postoperative complications constituted key prognostic factors.
CONCLUSION: For HCC in challenging liver segments VII and VIII, R-LR and RIO-RFA achieve comparable outcomes in de novo cases, whereas R-LR confers superior survival in recurrent disease. R-LR should be prioritized for small de novo HCCs and for recurrent disease overall; RIO-RFA may serve as an effective alternative in carefully selected low-risk recurrent patients. Tumor size, platelet count, and postoperative complications are key prognostic indicators to guide individualized treatment.