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Comparative Study
. 2025 Sep;77(5):1451-1462.
doi: 10.1007/s13304-025-02293-z. Epub 2025 Jul 20.

Robotic vs laparoscopic resection for hepatocellular carcinoma: multicentric propensity-score matched analysis of surgical and oncologic outcomes in 647 patients

Stefano Di Sandro  1 , Leonardo Centonze  2   3 , Francesca Ratti  4   5 , Nadia Russolillo  6 , Simone Conci  7 , Enrico Gringeri  8 , Francesco Ardito  9 , Marco Colasanti  10 , Carlo Sposito  11   12 , Riccardo De Carlis  2 , Mario Giuffrida  13 , Pasquale Bonsignore  14 , Matteo Zanello  15 , Samuele Frassoni  16   17 , Roberta Odorizzi  18 , Vincenzo Bagnardi  16 , Elio Jovine  15   19 , Salvatore Gruttadauria  14   20 , Maurizio Iaria  13 , Andrea Lauterio  2   21 , Vincenzo Mazzaferro  11   12 , Giuseppe Maria Ettorre  10 , Felice Giuliante  9 , Umberto Cillo  8 , Andrea Ruzzenente  7 , Alessandro Ferrero  6 , Luca Aldrighetti  4   5 , Fabrizio Di Benedetto  18 ; IGoMILS Collaborative Group
Collaborators, Affiliations
Comparative Study

Robotic vs laparoscopic resection for hepatocellular carcinoma: multicentric propensity-score matched analysis of surgical and oncologic outcomes in 647 patients

Stefano Di Sandro et al. Updates Surg. 2025 Sep.

Abstract

Background and objectives: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has been linked to several advantages compared to open approach, but the actual benefit of robotic liver resection (RLR) over LLR in HCC needs further investigation.

Methods: We performed a multicentric propensity-score matched (PSM) analysis comparing perioperative and oncologic outcomes of LLR vs. RLR for HCC. The PSM model was estimated using a multivariable logistic regression, with type of surgery as dependent variable and age, BMI, clinically-significant portal hypertension, αFP, size of principal lesion, number of nodules and Kawaguchi difficulty score as covariates. Overall (OS) and recurrence-free (RFS) survivals were estimated using the Kaplan-Meier method.

Results: Six-hundred-forty-seven HCC patients from 12 IGoMILS registry centers treated by LLR (553 patients) or RLR (94 patients) were included. After PSM, RLR resulted in wider surgical margins (median: 10 vs 5 mm; p = 0.002) with higher prevalence of R0 resection (98.9 vs 93.1%; p = 0.037), lower conversion rate (2.1 vs. 8.5%; p = 0.039) and shorter hospital stay (median: 4 vs 5 days; p = 0.025), with no significant difference in postoperative complication rate. We observed similar OS among RLR and LLR cohorts [5-y OS: 68.7 vs 65.0%; univariable HR = 0.95 (95% CI: 0.60-1.49); p = 0.82], with significantly better RFS in RLR cohort [5-y RFS: 46.8 vs 24.0%; univariable HR = 0.71 (95% CI: 0.52-0.98); p = 0.04].

Conclusions: Perioperative outcomes were significantly better in the RLR cohort, with a lower conversion rate and shorter hospital stay, although the latter may be influenced by the multi-institutional study design. Notably, we observed wider resection margins in the RLR group, which were associated with significantly improved RFS.

Keywords: Hepatocellular Carcinoma; Laparoscopic Liver Resection; Minimally Invasive Liver Surgery; Oncologic Outcomes; Robotic Liver Resection.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no competing interests, financial or non-financial, directly or indirectly related to the work submitted for publication. No specific funding was received for this study. Ethical approval: This study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent: Given the retrospective nature of the analysis, informed consent was not required.

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