Analysis of survival outcomes following robotic hepatectomy for malignant liver diseases

Background: Despite increased adoption of the robotic platform for complex hepatobiliary resections for malignant disease, little is known about long-term survival outcomes. This is the first study to evaluate the postoperative outcomes, and short- and long-term survival rates after a robotic hepatectomy for five major malignant disease processes. Methods: A prospectively collected database of patients who underwent a robotic hepatectomy for malignant disease was reviewed. Pathologies included colorectal liver metastases (CLM), hepatocellular carcinoma (HCC), Klatskin tumor, intrahepatic cholangiocarcinoma (IHCC), and gallbladder cancer (GC). Data are presented as median (mean +/- standard deviation) for illustrative purposes. Results: Of the 210 consecutive patients who underwent robotic hepatectomy for malignant disease, 75 (35 %) had CLM, 69 (33 %) had HCC, 27 (13 %) had Klatskin tumor, 20 (10 %) had IHCC, and 19 (9 %) had GC. Patients were 66 (65 +/- 12.4) years old with a BMI of 29 (29 +/- 6.5) kg/m2. R0 resection was achieved in 91 %, and 65 % underwent a major hepatectomy. Postoperative major complication rate was 6 %, length of stay was four (5 +/- 4.3) days, and 30-day readmission rate was 17 %. Survival at 1, 3, and 5-years were 93 %/75 %/72 % for CLM, 84 %/71 %/64 % for HCC, 73 %/55 %/55 % for Klatskin tumor, 80 %/69 %/69 % for IHCC, 79 %/65 %/65 % for GC. Conclusion: This study suggests a favorable 5-year overall survival benefit with use of the robotic platform in hepatic resection for colorectal metastases, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, Klatskin tumor, and gallbladder cancer. The robotic platform facilitates fine dissection in complex hepatobiliary operations, with a high rate of R0 resections and excellent perioperative clinical outcomes.