A Prospective Study Using Propensity Score Matching to Compare Long-term Survival Outcomes After Robotic-assisted, Laparoscopic or Open Liver Resection for Patients with BCLC Stage 0-A Hepatocellular Carcinoma.

To compare the short- and long-term outcomes of robot-assisted (RALR), laparoscopic (LLR), or open liver resection (OLR) in the treatment of BCLC stage 0-A hepatocellular carcinoma (HCC).Following the Balliol IDEAL classification, long-term oncological outcomes can be used to evaluate the value of minimally invasive techniques in the treatment of HCC, and to assess whether they should become a standard practice.Data from prospective cohorts of patients with BCLC stage 0-A HCC who underwent curative liver resection using OLR, LLR, or RALR at Tongji Hospital were reviewed. The short-term and long-term oncological outcomes of these three different surgical approaches after adequate follow-up were compared using propensity score matching to reduce selection bias.Of 369 patients included in this study (71, RALR; 141, LLR; and 157, OLR), 56 patients in each of the three groups were chosen for further comparison, after PSM. In the minimally invasive group (RALR+LLR), both the operative time and duration of Pringle's maneuver were significantly longer than those in the OLR group; however, the length of hospital stay was significantly shorter. There were no significant differences in the other intraoperative parameters and the incidence of postoperative complications among the three groups. HCC recurrence in the minimally invasive group when compared with the OLR group was characterized by a significantly higher proportion of single lesion or early stage HCC. However, there were no significant differences in the 5-year disease-free survival (DFS) (63.8%, 54.4%, and 50.6%) or overall survival rates (80.8%, 78.6%, and 75.7%, respectively) among the three groups. Clinically significant portal hypertension (CSPH) was the only risk factor that negatively affected the 5-year DFS rate. Multivariate Cox regression analysis showed that CSPH, serum alpha-fetoprotein level (≥400 ng/ml), and Edmondson-Steiner grading (III+IV) were independent risk factors for poor long-term survival.Both robotic and laparoscopic hepatectomies were safe and effective for patients with BCLC stage 0-A HCC when compared with open hepatectomy.