Feasibility of robotic liver resection compared with laparoscopic and open liver resection for hepatocellular carcinoma: a network meta-analysis

Abstract

BACKGROUND: Robotic liver resection (RLR) has gained popularity in the treatment of hepatocellular carcinoma (HCC); however, its efficacy compared to laparoscopic liver resection (LLR) and open liver resection (OLR) remains unclear. METHODS: Comprehensive literature search of electronic databases from January 2010 to December 2024 identified studies comparing RLR, LLR, or OLR. Operative, postoperative, and survival data were extracted, and pooled odd ratios or hazard ratios with 95% confidence intervals were calculated using a frequentist network meta-analysis including RLR, LLR, and OLR. RESULTS: A total of 69 studies, comprising 1 randomized controlled, 3 prospective, and 65 retrospective-matched studies, involving 13,257 patients were analyzed. This network meta-analysis showed that RLR had significantly lower blood loss than both OLR and LLR, with comparable operative time, RBC transfusion rates, Pringle maneuver use, Pringle time, and R1 resection rates. RLR showed similar rates of overall and major complications and hospital stay duration as LLR, with significant benefits over OLR. No significant differences in 90-day mortality were found among the three groups. For long-term outcomes, RLR showed no significant advantage over LLR or OLR in overall and recurrence-free survival, though it generally ranked higher with a greater P -score. CONCLUSIONS: This network meta-analysis suggests that RLR is a feasible surgical treatment option for HCC, offering perioperative and long-term outcomes comparable to LLR, with reduced postoperative morbidity and shorter hospital stays compared to OLR. However, further studies are needed to confirm RLR's efficacy due to its limited sample size.