Outcomes of robotic liver resection and intraoperative radiofrequency ablation for hepatocellular carcinoma in posterior segments VII and VIII.

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.