Abstract：
BACKGROUND: Evidence concerning long-term outcome of robotic liver resection (RLR) and laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) patients is scarce.
METHODS: This study enrolled all patients who underwent RLR and LLR for resectable HCC between July 2016 and July 2021. Propensity score matching (PSM) was employed to create a 1:3 match between the RLR and LLR groups. A comprehensive collection and analysis of patient data regarding efficacy and safety have been conducted, along with the evaluation of the learning curve for RLR.
RESULTS: Following PSM, a total of 341 patients were included, with 97 in the RLR group and 244 in the LLR group. RLR group demonstrated a significantly longer operative time (median [IQR], 210 [152.0-298.0] min vs. 183.5 [132.3-263.5] min; p = 0.04), with no significant differences in other perioperative and short-term postoperative outcomes. Overall survival (OS) was similar between the two groups (p = 0.43), but RLR group exhibited improved recurrence-free survival (RFS) (median of 65 months vs. 56 months, p = 0.006). The estimated 5-year OS for RLR and LLR were 74.8% (95% CI: 65.4-85.6%) and 80.7% (95% CI: 74.0-88.1%), respectively. The estimated 5-year RFS for RLR and LLR were 58.6% (95% CI: 48.6-70.6%) and 38.3% (95% CI: 26.4-55.9%), respectively. In the multivariate Cox regression analysis, RLR (HR: 0.586, 95% CI (0.393-0.874), p = 0.008) emerged as an independent predictor of reducing recurrence rates and enhanced RFS. The operative learning curve indicates that approximately after the 11th case, the learning curve of RLR stabilized and entered a proficient phase.
CONCLUSIONS: OS was comparable between RLR and LLR, and while RFS was improved in the RLR group. RLR demonstrates oncological effectiveness and safety for resectable HCC.
METHODS: This study enrolled all patients who underwent RLR and LLR for resectable HCC between July 2016 and July 2021. Propensity score matching (PSM) was employed to create a 1:3 match between the RLR and LLR groups. A comprehensive collection and analysis of patient data regarding efficacy and safety have been conducted, along with the evaluation of the learning curve for RLR.
RESULTS: Following PSM, a total of 341 patients were included, with 97 in the RLR group and 244 in the LLR group. RLR group demonstrated a significantly longer operative time (median [IQR], 210 [152.0-298.0] min vs. 183.5 [132.3-263.5] min; p = 0.04), with no significant differences in other perioperative and short-term postoperative outcomes. Overall survival (OS) was similar between the two groups (p = 0.43), but RLR group exhibited improved recurrence-free survival (RFS) (median of 65 months vs. 56 months, p = 0.006). The estimated 5-year OS for RLR and LLR were 74.8% (95% CI: 65.4-85.6%) and 80.7% (95% CI: 74.0-88.1%), respectively. The estimated 5-year RFS for RLR and LLR were 58.6% (95% CI: 48.6-70.6%) and 38.3% (95% CI: 26.4-55.9%), respectively. In the multivariate Cox regression analysis, RLR (HR: 0.586, 95% CI (0.393-0.874), p = 0.008) emerged as an independent predictor of reducing recurrence rates and enhanced RFS. The operative learning curve indicates that approximately after the 11th case, the learning curve of RLR stabilized and entered a proficient phase.
CONCLUSIONS: OS was comparable between RLR and LLR, and while RFS was improved in the RLR group. RLR demonstrates oncological effectiveness and safety for resectable HCC.
摘要：
背景：关于机器人肝切除术（RLR）和腹腔镜肝切除术（LLR）对肝细胞癌（HCC）患者的长期结果的证据很少。
方法：本研究纳入了2016年7月至2021年7月期间接受RLR和LLR治疗可切除HCC的所有患者。倾向评分匹配(PSM)用于在RLR和LLR组之间创建1:3匹配。对患者的疗效和安全性数据进行了全面的收集和分析，以及对RLR学习曲线的评估。
结果：在PSM之后，共纳入341名患者,RLR组中有97个，LLR组中有244个。RLR组的手术时间明显更长（中位数[IQR]，210[152.0-298.0]minvs.183.5[132.3-263.5]min;p=0.04),其他围手术期和术后短期结局无显著差异。两组总生存期（OS）相似（p=0.43），但RLR组表现出改善的无复发生存期（RFS）（中位数为65个月vs.56个月,p=0.006)。RLR和LLR的估计5年OS分别为74.8%（95%CI：65.4-85.6%）和80.7%（95%CI：74.0-88.1%），分别。RLR和LLR的估计5年RFS分别为58.6%（95%CI：48.6-70.6%）和38.3%（95%CI：26.4-55.9%），分别。在多元Cox回归分析中，RLR（HR：0.586，95%CI（0.393-0.874），p=0.008）是降低复发率和增强RFS的独立预测因子。手术学习曲线表明，大约在第11例之后，RLR的学习曲线趋于稳定，进入熟练阶段。
结论：操作系统在RLR和LLR之间具有可比性，而RLR组的RFS有所改善。RLR证明了可切除HCC的肿瘤学有效性和安全性。
方法：本研究纳入了2016年7月至2021年7月期间接受RLR和LLR治疗可切除HCC的所有患者。倾向评分匹配(PSM)用于在RLR和LLR组之间创建1:3匹配。对患者的疗效和安全性数据进行了全面的收集和分析，以及对RLR学习曲线的评估。
结果：在PSM之后，共纳入341名患者,RLR组中有97个，LLR组中有244个。RLR组的手术时间明显更长（中位数[IQR]，210[152.0-298.0]minvs.183.5[132.3-263.5]min;p=0.04),其他围手术期和术后短期结局无显著差异。两组总生存期（OS）相似（p=0.43），但RLR组表现出改善的无复发生存期（RFS）（中位数为65个月vs.56个月,p=0.006)。RLR和LLR的估计5年OS分别为74.8%（95%CI：65.4-85.6%）和80.7%（95%CI：74.0-88.1%），分别。RLR和LLR的估计5年RFS分别为58.6%（95%CI：48.6-70.6%）和38.3%（95%CI：26.4-55.9%），分别。在多元Cox回归分析中，RLR（HR：0.586，95%CI（0.393-0.874），p=0.008）是降低复发率和增强RFS的独立预测因子。手术学习曲线表明，大约在第11例之后，RLR的学习曲线趋于稳定，进入熟练阶段。
结论：操作系统在RLR和LLR之间具有可比性，而RLR组的RFS有所改善。RLR证明了可切除HCC的肿瘤学有效性和安全性。
