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Short- and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study

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Abstract

Background

Robotic liver resection (RLR) has increasingly been accepted as it has overcome some of the limitations of open liver resection (OLR), while the outcomes following RLR in elderly patients with hepatocellular carcinoma (HCC) are still uncertain. This study aimed to evaluate the short and long-term outcomes of RLR vs. OLR in elderly HCC patients.

Methods

Perioperative data of elderly patients (≥ 65 years) with HCC who underwent RLR or OLR between January 2010 and December 2020 were retrospectively analyzed. A 1:2 propensity score-matched (PSM) analysis was performed to minimize the differences between RLR and OLR groups. Univariable and multivariable Cox regression analyses were used to identify independent prognosis factors for overall survival (OS) and recurrence-free survival (RFS) of these patients.

Results

Of the 427 elderly HCC patients included in this study, 113 underwent RLR and 314 underwent OLR. After the 1:2 PSM, there were 100 and 178 patients in the RLR and the OLR groups, respectively. The RLR group had a less estimated blood loss (EBL), a shorter postoperative length of stay (LOS), and a lower complications rate (all P < 0.05), compared with the OLR group before and after PSM. Univariable and multivariable analyses showed that advanced age and surgical approaches were not independent risk factors for long-term prognosis. The two groups of elderly patients who were performed RLR or OLR had similar OS (median OS 52.8 vs. 57.6 months) and RFS (median RFS 20.4 vs. 24.6 months) rates after PSM.

Conclusions

RLR was comparable to OLR in feasibility and safety. For elderly patients with HCC, RLR resulted in similar oncologic and survival outcomes as OLR.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Xiu-Ping Zhang, Shuai Xu, and Ming-Gen Hu have contributed equally to this work.

Authors and Affiliations

  1. Faculty of Hepato-Biliary-Pancreatic Surgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Xiu-Ping Zhang, Shuai Xu, Ming-Gen Hu, Zhi-Ming Zhao, Zhao-Hai Wang, Guo-Dong Zhao, Cheng-Gang Li, Xiang-Long Tan & Rong Liu

  2. School of Medicine, Nankai University, Tianjin, China

    Shuai Xu & Rong Liu

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  1. Xiu-Ping Zhang
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Contributions

Conception and design: RL, XPZ, SX, MGH. Provision of study materials or patients: MGH, ZMZ, GDZ, ZHW, XLT, CGL, RL. Collection and assembly of data: XPZ, SX. Data analysis and interpretation: SX, XPZ. Manuscript writing: XPZ, SX, MGH. Final approval of manuscript: All authors. Financial support: RL.

Corresponding author

Correspondence to Rong Liu.

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Disclosures

Dr. Xiu-Ping Zhang, Shuai Xu, Ming-Gen Hu, Zhi-Ming Zhao, Zhao-Hai Wang, Guo-Dong Zhao, Cheng-Gang Li, Xiang-Long Tan, and Rong Liu have no conflicts of interest or financial ties to disclose.

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This study was approved by the Ethics Committee of the PLA general hospital, and written informed consent was obtained from all patients.

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Zhang, XP., Xu, S., Hu, MG. et al. Short- and long-term outcomes after robotic and open liver resection for elderly patients with hepatocellular carcinoma: a propensity score-matched study. Surg Endosc 36, 8132–8143 (2022). https://doi.org/10.1007/s00464-022-09236-4

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