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<p>Hepatocellular carcinoma (HCC) is still a leading indication of Surgical resection of a portion of the liver. Laparoscopic and robotic liver resections are some of the techniques that are becoming increasingly common. Although RLR is more dextrous and precise, its benefits over LLR remain controversial because of the variation in the methodology of studies and patient selection. This meta-analysis compared perioperative outcomes between robotic and laparoscopic liver resection in HCC, focusing on operative time, hospital stay, morbidity, mortality, transfusion needs, and bile leak rates. The quality of evidence was assessed using the GRADE approach. A systematic search of PubMed, Scopus, and Cochrane identified 520 records. Five multicenter propensity score–matched cohort studies involving 3,616 patients (Robotic: 3,283; Laparoscopic: 333) met the inclusion criteria. Data on perioperative outcomes were pooled, and the Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the studies. Compared with laparoscopic resection, robotic liver resection had a longer operative time (MD: −35.15&#xa0;min, 95% CI: −64.90 to − 5.39; <i>p</i> = 0.02; I² = 38%). However, there were no significant differences in blood transfusion rates (RR: 1.50, 95% CI: 0.41–5.47; <i>p</i> = 0.54), bile leaks (RR: 2.11, 95% CI: 0.59–7.52; <i>p</i> = 0.25), hospital stays (MD: −0.19 days, 95% CI: −2.42 to 2.05; <i>p</i> = 0.87; I² = 95%), or conversion to open surgery (RR: 1.22, 95% CI: 0.42–3.59; <i>p</i> = 0.71). RLR showed higher 30-day morbidity (RR: 1.59, 95% CI: 1.04–2.42; <i>p</i> = 0.03), while 90-day mortality did not differ significantly between the two approaches (RR: 4.33, 95% CI: 0.84–22.41; <i>p</i> = 0.08). RLR yields comparable results to LLR in HCC, with no differences in mortality or conversion rates but longer operative times and slightly higher short-term morbidity. Evidence quality was low to very low, emphasizing the need for well-designed randomized trials to inform surgical choices.</p>

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Evaluating robotic vs. laparoscopic liver resection for BCLC stage 0–I hepatocellular carcinoma: a meta-analysis of propensity score-matched studies on perioperative outcomes

  • 期刊论文

  • 发表日期：

    2025年11月25日

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  • Suleman Khan,
  • Muhammad Younas,
  • Aizaz Anwar Khalid,
  • Asim Shah,
  • Ali Fida Khan,
  • Zaryab Bacha,
  • FNU Misbahuddin,
  • Zain Afridi,
  • Aman Iqbal,
  • Komal Karmani,
  • Hammad Iftikhar,
  • Asad Jamal,
  • Muhammad Hassan Raza,
  • Muneeb Shad Mohmand,
  • Abdullah Afridi,
  • Asma Chaudhary,
  • Yasar Sattar

摘要

Hepatocellular carcinoma (HCC) is still a leading indication of Surgical resection of a portion of the liver. Laparoscopic and robotic liver resections are some of the techniques that are becoming increasingly common. Although RLR is more dextrous and precise, its benefits over LLR remain controversial because of the variation in the methodology of studies and patient selection. This meta-analysis compared perioperative outcomes between robotic and laparoscopic liver resection in HCC, focusing on operative time, hospital stay, morbidity, mortality, transfusion needs, and bile leak rates. The quality of evidence was assessed using the GRADE approach. A systematic search of PubMed, Scopus, and Cochrane identified 520 records. Five multicenter propensity score–matched cohort studies involving 3,616 patients (Robotic: 3,283; Laparoscopic: 333) met the inclusion criteria. Data on perioperative outcomes were pooled, and the Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the studies. Compared with laparoscopic resection, robotic liver resection had a longer operative time (MD: −35.15 min, 95% CI: −64.90 to − 5.39; p = 0.02; I² = 38%). However, there were no significant differences in blood transfusion rates (RR: 1.50, 95% CI: 0.41–5.47; p = 0.54), bile leaks (RR: 2.11, 95% CI: 0.59–7.52; p = 0.25), hospital stays (MD: −0.19 days, 95% CI: −2.42 to 2.05; p = 0.87; I² = 95%), or conversion to open surgery (RR: 1.22, 95% CI: 0.42–3.59; p = 0.71). RLR showed higher 30-day morbidity (RR: 1.59, 95% CI: 1.04–2.42; p = 0.03), while 90-day mortality did not differ significantly between the two approaches (RR: 4.33, 95% CI: 0.84–22.41; p = 0.08). RLR yields comparable results to LLR in HCC, with no differences in mortality or conversion rates but longer operative times and slightly higher short-term morbidity. Evidence quality was low to very low, emphasizing the need for well-designed randomized trials to inform surgical choices.