P. Magistri1,2, G. Tarantino1, G. Assirati1, T. Olivieri1, V. Serra1, N. De Ruvo1, R. Ballarin1, F. Di Benedetto1 1University Of Modena And Reggio Emilia,Hepato-Pancreato-Biliary Surgery And Liver Transplantation Unit,Modena, MO, Italy 2Sapienza – University Of Rome,Medical And Surgical Sciences And Translational Medicine,Rome, RM, Italy
Introduction: Hepatocellular carcinoma (HCC) has a growing incidence worldwide, and represents a leading cause of death in patients with cirrhosis. Nowadays minimally invasive approaches are spreading worldwide in every field of surgery and in liver surgery as well.
Methods: We retrospectively reviewed demographics, clinical and pathological characteristics and short-term outcomes of patients underwent minimally invasive resections for HCC at our Institution between June 2012 and May 2016.
Results: No significant differences in demographics and comorbidities were found between patients underwent laparoscopic (n=24) and robotic (n=22) liver resections, except for the rates of cirrhotic patients (91.7% and 68.2%, respectively, p=0.046). Peri-operative data analysis showed that the operative time (mean, 211 min and 318 min, respectively, p<0.001) was the only parameter in favor of laparoscopy. In fact, robotic approach allowed us to resect larger tumors (mean, 22.96 mm and 31.85 mm, respectively, p=0.02) with a statistically significant lower rate of conversions (16.7% vs. 0%, respectively, p=0.046). Moreover, robotic assisted resections were related to less Clavien I-II post-operative complications (22 vs. 14 cases, respectively, p=0.02). About resection margins, the two groups had similar rates of disease-free resection margins without any statistically significant difference.
Conclusion: A modern hepatobiliary center should offer both open and minimally invasive approaches to the liver disease, in order to provide the best care for each patient, according to the individual comorbidities, risk factors, and personal quality of life expectations. Our results show that the robotic approach is a reliable tool for an accurate oncologic surgery, comparable to the laparoscopic approach. Also, robotic surgery allows the surgeon to perform larger resections and to safely approach liver segments that are hardly resectable in laparoscopy, namely segment I-VII-VIII.