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Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study

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资源类型：
Pubmed体系：
作者：
Xia Feng[1] * ; Liu Xulin[1] ; Yan Jing[2] ; Qiu Zhancheng[3] ; Zhang Qiao[4] ; Wu Zhenheng[5] ; Huang Zhiyuan[6] ; Wei Renjie[7] ; Lin Li[8] ; Liu Liping[9] ; Han Shuangqin[10] ; Yuan Yulin[11] ; Yin Huaxuan[12] ; Xia Guobing[13] ; Wan Yunyan[14] ; Xiao Shuo[15] ; Li Jian[16] ; Zhou Guoxiang[17] ; Xia Xiafei[18] ; Sun Huapeng[19] ; Wang Shuai[20] ; Zheng Jun[21] ; Gao Hengyi[22] ; Zheng Jiang[23] ; Ren Li[24] ; Ali Mo[25] ; Fu Junquan[26] ; Ye Lin[27] ; Ruan Shun[28] ; Chen Xiaoping[1,*1] ; Cheng Qi[1,*1] ; Zhang Bixiang[1,*1] ; Zhu Peng[1,*1] ;
机构： [1]Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China. [2]Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China. [3]Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China. [4]Department of Hepatic Surgery, Zhongshan People's Hospital Affiliated to Guangdong Medical University, Zhongshan, Guangdong, China. [5]Department of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou, China. [6]Department of General Surgery, General Hospital of Central Theater Command, Wuhan, Hubei, China. [7]Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China. [8]Clinic Center of Human Gene Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. [9]Department of Hepatobiliary Surgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China. [10]Department of Hepatobiliary Surgery, Tianjin First Central Hospital, Tianjin Medical University, Tianjin, China. [11]School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China. [12]Department of Hepatic-biliary-pancreatic Surgery, The First People's Hospital of Foshan, Foshan,China. [13]Department of Hepatobiliary and Pancreatic Surgery, Huangshi Central Hospital, Hubei Polytechnic University, Huangshi, Hubei, China. [14]Department of Hepatobiliary Pancreatic Surgery, Taihe Hospital, Shiyan City, Hubei Province, China. [15]Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, Guangdong, China. [16]Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China. [17]Department of Heart Center, Women and Children's Hospital of Qingdao University, Qingdao, Shandong, China. [18]Department of Organ Transplantation, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China. [19]Department of General Surgery, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China. [20]Department of Hepatobiliary Surgery, Jingzhou Central Hospital, Jingzhou, China. [21]Department of Science and Education, Shenzhen Baoan District People's Hospital, Guangdong, China. [22]Department of Hepatobiliary and Pancreatic Surgery, Shenzhen Longhua District People's Hospital, Guangdong, China. [23]Department of Cardiology, Wuhan Yaxin General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China. [24]Department of Hepatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai, China. [25]Department of General Surgery, First Affiliated Hospital of Shaoyang University, Shaoyang City, Hunan, China. [26]Department of Hepatobiliary and Pancreatic Surgery, Bazhong Central Hospital, Bazhong, Sichuan, China. [27]Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region, China. [28]Department of Surgery, Dongguan Hepatobiliary Hospital, Dongguan, Guangdong, China.
出处：
DOI： 10.1097/JS9.0000000000003938
ISSN：

关键词： Hepatocellular carcinoma Recurrence Pattern Cost-effectiveness analysis Minimally invasive surgery Liver Rescetion

摘要：
Hepatectomy remains the standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage 0/A hepatocellular carcinoma (HCC). However, debates persist regarding the optimal surgical approach-robot-assisted (RALR), laparoscopic (LLR), or open liver resection (OLR)-due to differences in perioperative outcomes, recurrence patterns, and cost-effectiveness. While minimally invasive techniques offer potential advantages, such as reduced morbidity and faster recovery, their comprehensive impact remains unclear. This study evaluates and compares the intraoperative, postoperative, and economic outcomes of these three approaches in a multicenter cohort of BCLC 0/A HCC patients.Propensity score matching (PSM) was performed to balance baseline characteristics across RALR, LLR, and OLR groups (714 patients each). Intraoperative and postoperative outcomes, as well as long-term recurrence-free survival (RFS) and overall survival (OS), were assessed. Cost-effectiveness was evaluated using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs).This nationwide retrospective study analyzed 2882 BCLC 0/A HCC patients from 27 centers. After propensity score matching, 2142 patients were analyzed (714 in each group). Operative time was longer in RALR (225 min) and LLR (225 min) compared to OLR (170 min, P < 0.001). Postoperative complication rates were lower in RALR (12.5%) and LLR (13.4%) than in OLR (17.1%, P < 0.001), with fewer severe complications (Clavien-Dindo grade ≥ IIIa). The OLR group had a higher proportion of advanced-stage recurrences (BCLC B/C/D: 70.3%) versus RALR (37.9%) and LLR (35.9%) (P < 0.001). RALR achieved the highest 5-year QALYs (1.143) among the three groups, while LLR demonstrated superior cost-effectiveness with an ICER of -$24,379/QALY compared to OLR.For BCLC 0/A HCC patients, RALR and LLR demonstrated lower incidence and severity of complications, less advanced-stage recurrence, and higher cost-effectiveness compared to OLR. These findings support the broader adoption of minimally invasive techniques to improve long-term outcomes and quality of life. Despite RALR's higher initial costs, it remains a highly cost-effective option, offering superior quality of life and long-term economic benefits.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2026]版：
无
最新[2025]版：
大类 | 2 区 医学
小类 | 2 区 外科
第一作者：
第一作者机构： [1]Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
通讯作者：
通讯机构： [1]Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China. [*1]Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, China
推荐引用方式(GB/T 7714)：
Xia Feng,Liu Xulin,Yan Jing,et al.Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study[J].International Journal Of Surgery (London, England).2025,doi:10.1097/JS9.0000000000003938.
APA：
Xia Feng,Liu Xulin,Yan Jing,Qiu Zhancheng,Zhang Qiao...&Zhu Peng.(2025).Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study.International Journal Of Surgery (London, England),,
MLA：
Xia Feng,et al."Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study".International Journal Of Surgery (London, England) .(2025)

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