Robotic liver resection for primary and metastatic hepatobiliary cancer. A decade single-center experience on perioperative and overall survival outcomes.

Liver resection (LR) remains the only potentially curative treatment for primary and secondary hepatobiliary malignancies. Robotic surgery provides technical and short-term clinical advantages over laparoscopy, although concerns regarding oncological and medium/long-term survival outcomes persist. This study examines perioperative outcomes and medium-term oncological survivals of five hepatobiliary malignancies treated with robotic LR (RLR). Between 2013 and 2025, patients undergoing RLR for hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), perihilar cholangiocarcinoma (pCC), Colorectal Liver Metastasis (CRLM), and neuroendocrine tumor metastasis (NET) were consecutively enrolled. Demographic and perioperative variables, including mortality, were retrospectively analyzed. 305 patients were included (CRLM 38.4%, HCC 31.5%, ICC 13.8%, pCC 10.5%, and NET 5.8%). Groups differed significantly in age, comorbidities, and surgical complexity. The HCC group showed the highest Charlson Comorbidity Index (8 [IQR7–9], p < 0.001), while pCC exhibited the greatest operative difficulty according to the Tampa Difficulty Score (37 [IQR25–41], p < 0.001). The median operative time was 296 min [IQR 220–387], and estimated blood loss was 150 mL [IQR 50–300]. The conversion rate was low (1%), and R0-resection resulted 94.1%, although pCC had the highest R1 rate (15.6%). Overall postoperative morbidity was 33.1% and major complications occurred in 12.8%, with both rates highest in pCC (56.2% and 37.5%). 90-day mortality was 3.6% without differences across groups (p = 0.121). 3-years overall survivals for HCC, ICC, pCC, CRLM, and NET were 55.6%, 47.9%, 49.2%, 65.3%, and 90%, respectively. RLR yielded favorable perioperative outcomes with high R0 resection rate across different hepatobiliary malignancies, supporting its expansion and need for larger prospective multicenter studies.