Long-Term Oncologic Outcomes Following Robotic Liver Resections for Primary Hepatobiliary Malignancies: A Multicenter Study

Objective: Robotic liver surgery (RLS) has emerged as a feasible alternative to laparoscopic or open resections with comparable perioperative outcomes. Little is known about the oncologic adequacy of RLS. The aim of this study was to investigate the long-term oncologic outcomes for patients undergoing RLS for primary hepatobiliary malignancies. Methods: We performed an international, multi-center, retrospective study of patients who underwent RLS for hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), or gallbladder cancer (GBC) between 2006-2016. Age, gender, histology, resection margin status, extent of surgical resection, disease-free survival (DFS) and overall survival (OS) were retrospectively collected and analyzed. Results: Of the 61 included patients, 34 (56%) had RLS performed for HCC, 16 (26%) for CC, and 11 (18%) for GBC. The majority of resections were non-anatomical or segmental resections (39.3%), followed by central hepatectomy (18%), left lateral sectionectomy (14.8%), left hepatectomy (13.1%), right hepatectomy (13.1%), and right posterior segmentectomy (1.6%). R0 resection was achieved in 94% of HCC, 68% of CC, and 81.8% of GBC patients. Median hospital stay was 5 days and conversion to open surgery was needed in 7 patients (11.5%). Grade III-IV Dindo-Clavien complications occurred in 7 patients with no perioperative mortality. Median follow-up was 75 months (95% CI 36-113) and 5-year OS and DFS were 56% and 38%, respectively. When stratified by tumor type, 3-year OS was 90% for HCC, 65% for GBC and 49% for CC (p=0.01). Conclusion: RLS can be performed for primary hepatobiliary malignancies with long-term oncologic outcomes comparable to published open and laparoscopic data.