Robotic Liver Resection For Hepatocellular Carcinoma. Analysis of Surgical Margins and Clinical Outcomes From A Western Tertiary Hepatobiliary Center

Background: This study was undertaken to determine surgical outcomes of patients undergoing robotic hepatectomy for hepatocellular carcinoma (HCC) and to investigate the correlation between tumor distance to margin and perioperative outcomes, as well as overall survival (OS). To our knowledge, this study represents the largest series of robotic liver resection for HCC in North America. Methods We retrospectively analyzed 58 consecutive patients who underwent robotic liver resection for HCC. Patients were further stratified by tumor distance to margin (≤ 1mm, 1.1-9.9mm, ≥ 10mm) and their clinical outcomes including OS were compared. Results A majority of patients attained a greater than 1mm tumor distance to margin (81%). There were no differences in tumor size between patient cohorts who attained ≤ 1mm, 1.1-9.9mm, and ≥ 10mm margins. There were no differences in pre-, intra-, and postoperative outcomes among the three cohorts. Cost variables of interest were also similar. OS was highest in the > 10mm margin cohort, and this was statistically significant at 3 and 5 years. Conclusion Robotic HCC resection was associated with adequate tumor distance to margin. Wide margins ≥ 10mm is associated with the best OS.