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Published on: June 24, 2022
Robotic versus laparoscopic liver resection for the treatment of hepatocellular carcinoma: an observational study
Chenyue Yang1, Junhao Zheng1, Yewei Zhang1
1Zhejiang Key Laboratory of Multi-omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Background:
Compared to laparoscopic liver resection (LLR), robotic liver resection (RLR) can offer patients better outcomes but higher costs. And currently, real-world observational evidence from China regarding this topic remains understudied. This study aimed to compare the cost difference between RLR and LLR and its association with surgical difficulty, thereby providing new insights for surgical decision-making.
Methods:
We retrospectively collected data from patients with hepatocellular carcinoma (HCC) who underwent liver resection by a single medical team at one hospital in China, from January 2016 to July 2023. Patients were divided into the RLR group and the LLR group. We compared perioperative outcomes and medical costs before and after propensity score matching (PSM), then conducted subgroup analyses with surgical difficulty as a covariate.
Results:
A total of 277 patients were included (175 in LLR group and 102 in RLR group). After PSM, 162 patients (81 in each group) were included for further analysis. The results showed that RLR group had less intraoperative bleeding, fewer postoperative complications, shorter postoperative hospital stay, and better surgical safety compared to LLR group. RLR group had higher medical costs (¥82,885.3 vs. ¥58,643.8, P<0.001); however, the non-surgical costs of RLR group were significantly lower than LLR group. Additionally, there was no significant difference in costs between the two surgical methods in high-difficulty liver resections.
Conclusions:
For patients with HCC, RLR had better surgical safety and higher medical costs compared to LLR. However, the non-surgical costs of RLR were lower. Furthermore, the increase in surgical difficulty reduced the cost difference between the two surgical methods, recommending RLR for patients with high surgical difficulty.
