Comparative study of robotic and open liver caudate lobe tumor resection

doi:10.3877/cma.j.issn.1674-6899.2025.02.005

Abstract

Abstract:

Objective

To compare the therapeutic effect of robot-assisted and traditional open surgery in caudate lobectomy.

Methods

A total of 77 patients with hepatocellular carcinoma in the caudate lobe who underwent robotic or open resection in the First Medical Center of Chinese PLA General Hospital from May 2010 to May 2024 were retrospectively enrolled, 61 males and 16 females. There were 50 patients in the open group and 27 patients in the robotic group, with an average age of 58.03±9.64 years.Demographic data, perioperative outcomes and differences in survival outcomes were collected. Propensity scoring match (PSM) was used to balance the baseline data. After PSM, 28 patients were included in the laparotomy group and 18 patients were included in the robot group. The differences in perioperative and prognostic indicators between the two groups were compared after matching.

Results

There were no significant differences in baseline data between the two groups. After PSM, the median (inter quartile range,IQR) operation time and blood loss were 117.50 (107.00, 185.00) min and 50.00 (20.00, 100.00) ml in the robot group, respectively. The postoperative hospital stay was 5.00 (4.00, 6.00) days. There was no conversion to open surgery and no serious postoperative complications. In the open surgery group, the median operation time was 180.50(160.75, 240.00) min, the blood loss was 300.00 (100.00, 425.00) ml, the postoperative hospital stay was 8.50 (7.00, 11.00) d, and 2 patients (7.14%) had severe ascites. Then abdominal puncture and drainage were performed under ultrasound guidance. However, the recurrence free survival (RFS) was (29 months vs. 31 months, P=0.798), the overall survival (OS) was (55 months vs.60 months, P=0.974), and the recurrence free survival (RFS) was (29 months vs. 31 months, P=0.798) in the two groups. The difference was not statistically significant. Multivariate Cox analysis showed that AFP>400 μg/L (P=0.008), tumor diameter >5 cm (P=0.020), multiple tumors (P=0.010), and poor tumor differentiation (P=0.009) were independent risk factors for RFS. microvascular invasion (MVI)and poor tumor differentiation were independent influencing factors for OS (P<0.05).

Conclusion

Robot-assisted caudate lobectomy is superior to open surgery in terms of operation time, blood loss and postoperative hospital stay. There was no significant difference in RFS and OS between the two surgical methods. Robotic hepatic caudate lobectomy is a safe, effective and minimally invasive procedure.

Key words: Robot-assisted, Open surgery, Caudate lobe hepatectomy, Prognostic analysis

Kai Liu, Pengjiong Liu, Zhenqi Li, Chen Feng, Yu Cao, Minggen Hu, Rong Liu. Comparative study of robotic and open liver caudate lobe tumor resection[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(02): 90-97.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2025.02.005

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2025/V18/I02/90

Figures/Tables 6

变量	开腹组 (n =50)	机器人组 (n =27)	统计量值	P值	SMD
年龄( $\overset{ˉ}{x}$ ± s ,岁)	58. 48　±　9. 13	57. 19　±　10. 65	t=-0. 56	0. 577	0. 122
BMI　( $\overset{ˉ}{x}$ ± s ,kg/ m²)	24. 94　±　3. 52	24. 50　±　2. 98	t=-0. 55	0. 587	0. 146
ALB( $\overset{ˉ}{x}$ ± s ,g/ L)	40. 66　±　4. 99	39. 79　±　3. 89	t=-0. 79	0. 433	0. 225
性别[男性,例(%)]	44　(88. 00)	17　(62. 96)	χ ²=6. 68	0. 010	0. 518
糖尿病[例(%)]	10　(20. 00)	7　(25. 93)	χ ²=0. 36	0. 550	0. 148
高血压[例(%)]	16　(32. 00)	10　(37. 04)	χ ²=0. 20	0. 656	0. 104
心脏病[例(%)]	2　(4. 00)	3　(11. 11)	χ ²=0. 52	0. 469	0. 226
乙型肝炎[例(%)]	38　(76. 00)	22　(81. 48)	χ ²=0. 31	0. 580	0. 141
AFP[例(%)]			χ ²=0. 14	0. 706	0. 093
≤400　μg/ L	35　(70. 00)	20　(74. 07)
>400　μg/ L	15　(30. 00)	7　(25. 93)
Child　Pugh 分级[例(%)]			χ ²=0. 00	>0. 999	0. 054
A	47　(94. 00)	25　(92. 59)
B	3　(6. 00)	2　(7. 41)
肝硬化[例(%)]	36　(72. 00)	18　(66. 67)	χ ²=0. 24	0. 626	0. 113
BCLC 分级[例(%)]			χ ²=0. 00	0. 996	0. 092
0～A	43　(86. 00)	24　(88. 89)
B～C	7　(14. 00)	3　(11. 11)
ASA 分级[例(%)]			χ ²=0. 07	0. 798	0. 136
1/2	45　(90. 00)	23　(85. 19)
3/4	5　(10. 00)	4　(14. 81)
肿瘤最大径[例(%)]			χ ²=4. 22	0. 040	0. 572
≤5　cm	27　(54. 00)	21　(77. 78)
>5　cm	23　(46. 00)	6　(22. 22)
多发病灶[例(%)]	6　(12. 00)	3　(11. 11)	χ ²=0. 00	>0. 999	0. 028
MVI[例(%)]	9　(18. 00)	9　(33. 33)	χ ²=2. 30	0. 129	0. 325
分化程度[例(%)]			χ ²=1. 05	0. 592
高	6　(12. 00)	2　(7. 41)			0. 175
中	22　(44. 00)	15　(55. 56)			0. 233
低	22　(44. 00)	10　(37. 04)			0. 144

变量	开腹组 (n =50)	机器人组 (n =27)	统计量值	P值	SMD
年龄( $\overset{ˉ}{x}$ ± s ,岁)	58. 48　±　9. 13	57. 19　±　10. 65	t=-0. 56	0. 577	0. 122
BMI　( $\overset{ˉ}{x}$ ± s ,kg/ m²)	24. 94　±　3. 52	24. 50　±　2. 98	t=-0. 55	0. 587	0. 146
ALB( $\overset{ˉ}{x}$ ± s ,g/ L)	40. 66　±　4. 99	39. 79　±　3. 89	t=-0. 79	0. 433	0. 225
性别[男性,例(%)]	44　(88. 00)	17　(62. 96)	χ ²=6. 68	0. 010	0. 518
糖尿病[例(%)]	10　(20. 00)	7　(25. 93)	χ ²=0. 36	0. 550	0. 148
高血压[例(%)]	16　(32. 00)	10　(37. 04)	χ ²=0. 20	0. 656	0. 104
心脏病[例(%)]	2　(4. 00)	3　(11. 11)	χ ²=0. 52	0. 469	0. 226
乙型肝炎[例(%)]	38　(76. 00)	22　(81. 48)	χ ²=0. 31	0. 580	0. 141
AFP[例(%)]			χ ²=0. 14	0. 706	0. 093
≤400　μg/ L	35　(70. 00)	20　(74. 07)
>400　μg/ L	15　(30. 00)	7　(25. 93)
Child　Pugh 分级[例(%)]			χ ²=0. 00	>0. 999	0. 054
A	47　(94. 00)	25　(92. 59)
B	3　(6. 00)	2　(7. 41)
肝硬化[例(%)]	36　(72. 00)	18　(66. 67)	χ ²=0. 24	0. 626	0. 113
BCLC 分级[例(%)]			χ ²=0. 00	0. 996	0. 092
0～A	43　(86. 00)	24　(88. 89)
B～C	7　(14. 00)	3　(11. 11)
ASA 分级[例(%)]			χ ²=0. 07	0. 798	0. 136
1/2	45　(90. 00)	23　(85. 19)
3/4	5　(10. 00)	4　(14. 81)
肿瘤最大径[例(%)]			χ ²=4. 22	0. 040	0. 572
≤5　cm	27　(54. 00)	21　(77. 78)
>5　cm	23　(46. 00)	6　(22. 22)
多发病灶[例(%)]	6　(12. 00)	3　(11. 11)	χ ²=0. 00	>0. 999	0. 028
MVI[例(%)]	9　(18. 00)	9　(33. 33)	χ ²=2. 30	0. 129	0. 325
分化程度[例(%)]			χ ²=1. 05	0. 592
高	6　(12. 00)	2　(7. 41)			0. 175
中	22　(44. 00)	15　(55. 56)			0. 233
低	22　(44. 00)	10　(37. 04)			0. 144

变量	开腹组 (n =28)	机器人组 (n =18)	统计量值	P值	SMD
年龄( $\overset{ˉ}{x}$ ± s ,岁)	59. 71　±　10. 33	57. 28　±　10. 59	t=0. 77	0. 444	0. 230
BMI　( $\overset{ˉ}{x}$ ± s ,kg/ m²)	24. 87　±　3. 00	24. 77　±　2. 86	t=0. 12	0. 904	0. 038
ALB( $\overset{ˉ}{x}$ ± s ,g/ L)	41. 14　±　5. 15	40. 31　±　3. 55	t=0. 60	0. 551	0. 235
性别[男性,例(%)]	23　(82. 14)	13　(72. 22)	χ ²=0. 18	0. 667	0. 221
糖尿病[例(%)]	8　(28. 57)	6　(33. 33)	χ ²=0. 12	0. 732	0. 101
高血压[例(%)]	11　(39. 29)	7　(38. 89)	χ ²=0. 00	0. 979	0. 008
心脏病[例(%)]	2　(7. 14)	2　(11. 11)	χ ²=0. 00	>0. 999	0. 126
乙型肝炎[例(%)]	19　(67. 86)	13　(72. 22)	χ ²=0. 10	0. 754	0. 097
AFP[例(%)]			χ ²=1. 00	0. 318	0. 285
≤400　μg/ L	21　(75. 00)	11　(61. 11)
>400　μg/ L	7　(25. 00)	7　(38. 89)
Child　Pugh 分级[例(%)]			-	>0. 999	0. 087
A	27　(96. 43)	17　(94. 44)
B	1　(3. 57)	1　(5. 56)
肝硬化[例(%)]	20　(71. 43)	11　(61. 11)	χ ²=0. 53	0. 466	0. 212
BCLC 分级[例(%)]			χ ²=0. 00	>0. 999	0. 032
0～A	23　(82. 14)	15　(83. 33)
B～C	5　(17. 86)	3　(16. 67)
ASA 分级[例(%)]			χ ²=0. 00	>0. 999	0. 126
1/2	26　(92. 86)	16　(88. 89)
3/4	2　(7. 14)	2　(11. 11)
肿瘤最大径[例(%)]			χ ²=0. 03	0. 869	0. 051
≤5　cm	18　(64. 29)	12　(66. 67)
>5　cm	10　(35. 71)	6　(33. 33)
多发病灶[例(%)]	4　(14. 29)	3　(16. 67)	χ ²=0. 00	>0. 999	0. 064
MVI[例(%)]	8　(28. 57)	5　(27. 78)	χ ²=0. 00	0. 953	0. 018
分化程度[例(%)]			-	>0. 999
高	3　(10. 71)	1　(5. 56)			0. 225
中	14　(50. 00)	10　(55. 56)			0. 112
低	11　(39. 29)	7　(38. 89)			0. 008

变量	开腹组 (n =28)	机器人组 (n =18)	统计量值	P值	SMD
年龄( $\overset{ˉ}{x}$ ± s ,岁)	59. 71　±　10. 33	57. 28　±　10. 59	t=0. 77	0. 444	0. 230
BMI　( $\overset{ˉ}{x}$ ± s ,kg/ m²)	24. 87　±　3. 00	24. 77　±　2. 86	t=0. 12	0. 904	0. 038
ALB( $\overset{ˉ}{x}$ ± s ,g/ L)	41. 14　±　5. 15	40. 31　±　3. 55	t=0. 60	0. 551	0. 235
性别[男性,例(%)]	23　(82. 14)	13　(72. 22)	χ ²=0. 18	0. 667	0. 221
糖尿病[例(%)]	8　(28. 57)	6　(33. 33)	χ ²=0. 12	0. 732	0. 101
高血压[例(%)]	11　(39. 29)	7　(38. 89)	χ ²=0. 00	0. 979	0. 008
心脏病[例(%)]	2　(7. 14)	2　(11. 11)	χ ²=0. 00	>0. 999	0. 126
乙型肝炎[例(%)]	19　(67. 86)	13　(72. 22)	χ ²=0. 10	0. 754	0. 097
AFP[例(%)]			χ ²=1. 00	0. 318	0. 285
≤400　μg/ L	21　(75. 00)	11　(61. 11)
>400　μg/ L	7　(25. 00)	7　(38. 89)
Child　Pugh 分级[例(%)]			-	>0. 999	0. 087
A	27　(96. 43)	17　(94. 44)
B	1　(3. 57)	1　(5. 56)
肝硬化[例(%)]	20　(71. 43)	11　(61. 11)	χ ²=0. 53	0. 466	0. 212
BCLC 分级[例(%)]			χ ²=0. 00	>0. 999	0. 032
0～A	23　(82. 14)	15　(83. 33)
B～C	5　(17. 86)	3　(16. 67)
ASA 分级[例(%)]			χ ²=0. 00	>0. 999	0. 126
1/2	26　(92. 86)	16　(88. 89)
3/4	2　(7. 14)	2　(11. 11)
肿瘤最大径[例(%)]			χ ²=0. 03	0. 869	0. 051
≤5　cm	18　(64. 29)	12　(66. 67)
>5　cm	10　(35. 71)	6　(33. 33)
多发病灶[例(%)]	4　(14. 29)	3　(16. 67)	χ ²=0. 00	>0. 999	0. 064
MVI[例(%)]	8　(28. 57)	5　(27. 78)	χ ²=0. 00	0. 953	0. 018
分化程度[例(%)]			-	>0. 999
高	3　(10. 71)	1　(5. 56)			0. 225
中	14　(50. 00)	10　(55. 56)			0. 112
低	11　(39. 29)	7　(38. 89)			0. 008

变量	开腹组 (n =28)	机器人组 (n =18)	P值
手术时间(min)	180. 50　(160. 75,　240. 00)	117. 50　(107. 00,　185. 00)	0. 002
肝门阻断时间(min)	6. 00　(0. 00,　18. 00)	18. 50　(0. 00,　27. 75)	0. 148
术中预计出血量(ml)	300. 00　(100. 00,　425. 00)	50. 00　(20. 00,　100. 00)	＜0. 001
术后住院时间(d)	8. 50　(7. 00,　11. 00)	5. 00　(4. 00,　6. 00)	＜0. 001
肝门阻断[例(%)]	15　(53. 57)	12　(66. 67)	0. 379
术中输血[例(%)]	6　(21. 43)	2　(11. 11)	0. 615
肿瘤距切缘[例(%)]			0. 337
≤1　cm	18　(64. 29)	9　(50. 00)
>1　cm	10(35. 71)	9　(50. 00)
切缘阳性[例(%)]	0(0. 00)	0　(0. 00)	-
严重并发症[例(%)]	2　(7. 14)	0　(0. 00)	0. 513

变量	单因素Cox 回归		多因素Cox 回归
变量	P值	HR (95%CI)	P值	HR (95%CI)
开腹组　vs. 　机器人组	0. 841	0. 94 (0. 49～1. 79)
年龄(≤60 岁　vs. 　>60 岁)	0. 261	0. 68　(0. 35～1. 33)
性别(女性　vs. 　男性)	0. 384	1. 41　(0. 65～3. 06)
BMI(≤24　kg/ m²vs. 　>24　kg/ m²)	0. 268	1. 42　(0. 76～2. 64)
乙肝(无　vs. 　有)	0. 818	1. 10　(0. 49～2. 49)
AFP(≤400　μg/ L　vs. 　>400　μg/ L)	0. 003	2. 75　(1. 40～5. 37)	0. 008	2. 66 (1. 29～5. 50)
Child　Pugh 分级(A　vs. 　B)	0. 354	1. 63　(0. 58～4. 61)
肝硬化(无　vs. 　有)	0. 651	0. 86　(0. 44～1. 66)
BCLC 分期(0～A　vs. 　B～C)	0. 277	1. 78　(0. 63～5. 03)
ASA 分级(1/2　vs. 　3/4)	0. 299	0. 54　(0. 17～1. 74)
肿瘤直径(≤5　cm　vs. 　>5　cm)	0. 297	1. 46　(0. 72～2. 99)	0. 020	2. 87　(1. 18～6. 99)
肿瘤距切缘(＜1　cm　vs.>1cm)	0. 277	0. 69　(0. 35～1. 35)	0. 137	0. 57　(0. 27～1. 20)
多发病灶(否　vs. 　是)	0. 249	1. 84　(0. 65～5. 21)	0. 010	4. 71　(1. 46～15. 24)
MVI(否　vs. 　是)	0. 217	1. 58　(0. 77～3. 24)	0. 172	1. 84　(0. 77～4. 43)
肿瘤分化程度
高		1. 00　(reference)
中	0. 161	2. 39　(0. 71～8. 08)	0. 207	2. 28　(0. 63～8. 22)
低	0. 010	5. 01　(1. 46～17. 19)	0. 009	5. 72　(1. 54～21. 18)

变量	单因素Cox 回归		多因素Cox 回归
变量	P值	HR (95%CI)	P值	HR (95%CI)
开腹组 vs. 机器人组	0. 500	0. 74 (0. 31～1. 78)
年龄(≤60 岁vs. 　>60 岁)	0. 172	0. 50　(0. 19～1. 35)
性别(女性　vs. 　男性)	0. 195	2. 22　(0. 66～7. 42)
BMI(≤24　kg/ m²　vs. 　>24　kg/ m²)	0. 096	2. 04　(0. 88～4. 73)
乙肝(无　vs. 　有)	0. 949	1. 04　(0. 35～3. 02)
AFP(≤400　μg/ L　vs. 　>400　μg/ L)	0. 018	2. 77　(1. 19～6. 44)	0. 070	2. 39 (0. 93～6. 14)
Child　Pugh 分级(A　vs. 　B)	0. 053	2. 89　(0. 99～8. 45)
肝硬化(无　vs. 　有)	0. 316	1. 65　(0. 62～4. 40)
BCLC 分期(0～A　vs. 　B～C)	0. 069	2. 76　(0. 92～8. 21)
ASA 分级(1/2　vs. 　3/4)	0. 849	0. 87　(0. 20～3. 72)
肿瘤直径(≤5　cm　vs. 　>5　cm)	0. 723	0. 85　(0. 36～2. 05)	0. 053	2. 78　(0. 99～7. 84)
肿瘤距切缘(＜1　cm　vs. 　>1　cm)	0. 629	0. 81　(0. 34～1. 93)	0. 470	2. 48　(0. 49～12. 43)
多发病灶(否　vs. 　是)	0. 832	1. 17　(0. 27～4. 99)	0. 271	2. 48　(0. 49～12. 43)
MVI(否　vs. 　是)	0. 011	2. 83　(1. 27～6. 33)	0. 011	3. 36　(1. 32～8. 54)
肿瘤分化程度
高		1. 00　(reference)
中	0. 538	1. 63　(0. 34～7. 75)	0. 541	1. 66　(0. 33～8. 47)
低	0. 014	6. 50　(1. 47～28. 85)	0. 013	7. 19　(1. 51～34. 28)

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