A meta-analytic and systematic review to compare perioperative outcomes and prognosis between robotic and conventional (laparoscopic or open) liver resection in hepatocellular carcinoma cases.

[BACKGROUND] Hepatectomy can be performed via laparoscopic liver resection (LLR), open liver resection (OLR), and robotic liver resection (RLR). However, the advantages of RLR over LLR and OLR with respect to the prognosis and perioperative outcomes of individuals with hepatocellular carcinoma (HCC) remain unclear. This study was designed to compare the perioperative and prognostic outcomes of RLR with those of LLR and OLR in patients with HCC.

[METHODS] A comprehensive literature search was conducted in Embase, the Cochrane Library, PubMed, and Web of Science using the following keywords: "liver resection," "robotic," and "hepatocellular carcinoma." The primary endpoints were overall survival (OS) and recurrence-free survival (RFS), with outcomes expressed as hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Secondary endpoints were perioperative outcomes, including resection margin status, intraoperative blood loss, transfusion requirement, operative time, conversion rate, postoperative complications, and length of hospital stay, reported as risk ratios (RRs) or mean differences (MDs) with 95% CIs.

[RESULTS] Eighteen studies involving 4,098 patients were included. Twelve studies reported the long-term prognosis of patients, with six comparing RLR with LLR, four comparing RLR with OLR, and two comparing RLR with LLR and OLR. Sixteen studies reported perioperative outcomes. The meta-analysis illustrated that RLR was associated with improved RFS (HR 0.78, 95% CI 0.64-0.94; p = 0.0092) and OS (HR 0.72, 95% CI 0.56-0.92; p = 0.0101) compared with LLR. No significant differences in OS and RFS were observed between RLR and OLR. Compared with LLR, RLR was associated with a lower conversion rate to laparotomy (RR 0.50, 95% CI 0.31-0.79; p = 0.0034) and a longer operative time (MD 30.69 min, 95% CI 9.56-51.82; p = 0.0044). RLR also resulted in significantly lower rates of overall complications (RR 0.60, 95% CI 0.37-0.98; p = 0.0402), severe complications (RR 0.41, 95% CI 0.24-0.70; p = 0.0011, respectively), and a shorter hospital stay (MD - 3.70 days, 95% CI - 4.80 to - 2.61; p < 0.0001).

[CONCLUSION] In patients with HCC, RLR is associated with superior prognosis and perioperative outcomes compared with LLR and RLR exhibits better perioperative outcomes than OLR.