To compare the short-term efficacy and long-term prognosis of robot-assisted hepatectomy versus laparoscopic hepatectomy in the treatment of hepatocellular carcinoma (HCC).

This retrospective study analyzed patients with hepatocellular carcinoma who underwent robot-assisted hepatectomy or laparoscopic hepatectomy in the Department of Hepatobiliary and Liver Transplantation Surgery, Gulou Hospital affiliated to Nanjing Medical University between 2021 and 2023. After applying the inclusion and exclusion criteria, a total of 221 patients were included, including 51 patients in the robotic group and 170 patients in the laparoscopic group. Propensity score matching (PSM) was performed at a 1∶1 ratio between the two groups. Perioperative outcomes, including hepatic inflow occlusion time, operative time, intraoperative blood loss, intraoperative transfusion volume, conversion to open surgery, 30-day readmission, postoperative complications, and length of hospital stay, were compared between the groups. Kaplan-Meier analysis was used to estimate and compare progression-free survival (PFS) between the two groups.

Before PSM, the robotic liver resection group exhibited shorter PT duration (P=0.022) and a lower incidence of cirrhosis (P=0.009). Patients in the robotic hepatectomy group had significantly larger tumor diameters in the resected specimens compared with those in the laparoscopic group (P=0.007). The robotic approach demonstrated a more pronounced advantage in conventional major hepatectomy (P<0.001) and showed stronger selectivity in surgeries with high Iwate difficulty scores (P<0.001). Perioperative outcomes before matching indicated that the robotic group had a significantly longer operative time than the laparoscopic group (200 min vs. 180 min, P=0.006) and a higher rate of Clavien-Dindo complications (Grade Ⅰ+ Ⅱ+ Ⅲ: 21.6% vs. 7.6%, P=0.020). After PSM, no significant differences were observed between the two groups in perioperative outcomes, including operative time, hepatic inflow occlusion time, intraoperative blood loss, intraoperative transfusion, postoperative hospital stay, conversion to open surgery, 30-day readmission, or Clavien-Dindo complication grade (all P>0.05). Long-term prognosis before and after PSM also showed no statistically significant difference in PFS between the robotic and laparoscopic groups (P>0.05).

Robot-assisted hepatectomy is an acceptable alternative to laparoscopic hepatectomy for the treatment of HCC, with no statistically significant difference in overall safety between the two approaches. Notably, the robotic approach may offer potential advantages in complex hepatectomy procedures and long-term prognosis (PFS).