Robot-assisted versus open hepatectomy for liver tumors: Systematic review and meta-analysis

Abstract

Background: This meta-analysis was conducted to evaluate the effectiveness and safety of robot-assisted hepatectomy (RAH) versus open hepatectomy (OH) for liver tumors (LT). Methods: A computer-based literature search was conducted to identify all randomized or nonrandomized controlled trials of RAH and OH in the treatment of LT from January 2000 to July 2022. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled values, using a fixed-effects or random-effects model. Results: Eight studies were included, with a combined total of 1079 patients. Compared with the OH group, the RAH group was found to involve less blood loss (standardized mean difference [SMD] = −152.52 mL; 95% confidence interval [CI] = −266.85 to 38.18; p = 0.009), shorter hospital stay (SMD = −2.79; 95% CI = −4.19 to −1.40; p < 0.001), a lower rate of postoperative complications (odds ratio [OR] =0.67; 95% CI = 0.47-0.95; p = 0.02), and a lower recurrence rate (OR = 0.42; 95% CI = 0.23-0.77; p = 0.005). However, operative time was longer in the RAH group than in the OH group (SMD = 70.55; 95% CI = 37.58-103.53; p < 0.001). Conclusion: This systematic review shows that RAH is safe and feasible in the treatment of LT.

Minimally invasive surgery for hepatocellular carcinoma

“…9 Additionally, incomplete resection and/or positive surgical margin (PSM) is always the key cause of the failure after treatment. 6,8,11 In the current study, 13 the difference of wideness of resection-free margin between RH and OH did not reach the statistical significance. The authors found the wideness of resection-free margin was less but recurrence rate was lower in the RH group than OH group.…”

“…13 In term of other parameters, such as resection-free margin (SMD −0.3 cm; 95% CI, −0.75 to −0.16), and the need of blood transfusion (OR, 1.01; 95% CI, 0.33-3.07) were similar between RH and OH groups. 13 Based on the aforementioned findings, the authors concluded that RH is safe and feasible in the treatment of HCC. 13 The current article is very interesting and worthy of further discussion.…”

“…It is well known that complete tumor resection (sometimes it can be reflective by wideness of resection-free margin) is the most critical and independent prognostic factor involving both progressive-free survival (PFS, reflective by recurrence rate) and overall survival (OS) in patients undergoing the surgical treatment for their malignant diseases, 14 contributing to the critical and major concern about the choice of surgical methods as well as an identification of the risk factors associated with incomplete resection. In the current study, 13 neither incomplete resection nor OS was investigated. However, the relationship between wideness of resection-free margin and recurrence rate seemed to be conflicted, since in theory, traditionally, many surgeons favor the “radicality” for complete resection of the malignant tumor as a standard surgical therapy.…”

“…13 Based on the aforementioned findings, the authors concluded that RH is safe and feasible in the treatment of HCC. 13 The current article is very interesting and worthy of further discussion.…”

“…The authors found the wideness of resection-free margin was less but recurrence rate was lower in the RH group than OH group. 13 Additionally, recurrence of cancer is a reflective of therapeutic failure, which is often related to survival (mortality). 14 This needs clarification.…”