Liver resection in stage 0-A HCC in segments 7/8: a propensity-matched analysis comparing open, laparoscopic, and robotic approach

Background Both laparoscopic hepatectomy (LH) and robotic hepatectomy (RH) have been performed for tumors in nearly all liver segments. However, few studies have compared the outcomes of patients who underwent open hepatectomy (OH), LH and RH for the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A HCC in S7/8. Methods The clinical data of patients who underwent S7/8 resection for the treatment of BCLC stage 0-A HCC in the First Affiliated Hospital of Guangxi Medical University from July 2017 to July 2023 were retrospectively collected. To minimize selection bias, propensity score matching (PSM) analysis was performed using American Society of Anesthesiology (ASA), tumor size, body mass index (BMI), alpha-fetoprotein (AFP), tumor location, age, number of tumors, platelet (PLT), and Viral hepatitis. Results A total of 401 patients met the study criteria. After PSM, 61 OH (28.6%), 74 LH (34.8%), and 78 RH (36.6%) were included. RH group had the least blood loss among the three groups (OH, 300 vs. LH, 215 vs. RH, 100 mL, P < 0.001). Conversion rate was significantly lower in RH group compared to LH group [LH, 10 (13.5%) vs. RH, 1 (1.3%), P = 0.003]. Although minimally invasive group (RH + LH) took slightly longer operative time (OH, 233 vs. LH, 255.5 vs. RH, 257 min, P = 0.068), there was no statistical difference. The minimally invasive group had fewer postoperative hospital stay (OH, 8 vs. LH, 6 vs. RH, 6 days, P < 0.001). The minimally invasive group had lower rates of surgical complications (OH, 37.7% vs. LH, 20.3% vs. RH, 11.5%). However, there were no statistically significant variations observed in the disease-free survival or overall survival rates among the three groups. Conclusions RH showed advantage over the OH and LH in short-term outcomes, and non-inferiority in survival outcomes for the treatment of BCLC stage 0-A HCC patients.