Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study
Rattachement africain : cn, hk. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND AND AIM: 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, 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. METHOD: Propensity score matching (PSM) was used to balance baseline characteristics across RALR, LLR, and OLR groups (714 patients each). Intraoperative and postoperative outcomes, as well as recurrence-free survival and overall survival, were assessed. Cost-effectiveness was assessed based on quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULT: This nationwide retrospective study analyzed 2882 BCLC 0/A HCC patients from 27 centers. After PSM, 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%), with fewer severe complications. 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. CONCLUSION: 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 (QoL). Despite RALR's higher initial costs, it remains a highly cost-effective option, offering superior QoL and long-term economic benefits.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Clinical and economic outcomes of robotic-assisted, laparoscopic, and open liver resection in BCLC 0/A hepatocellular carcinoma: a nationwide cohort study
- Date Crossref
- 21/11/2025
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Tongji Hospital pays non établi dans la noticeÉtablissement de santé
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Huazhong University of Science and Technology Department of Hepatic Surgery pays non établi dans la noticeUniversité ou école supérieure
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Second Affiliated Hospital of Zhejiang University Department of Ultrasound in Medicine pays non établi dans la noticeÉtablissement de santé
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Sichuan University Department of General Surgery pays non établi dans la noticeUniversité ou école supérieure
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West China Hospital of Sichuan University pays non établi dans la noticeÉtablissement de santé
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Zhongshan People's Hospital Department of Hepatic Surgery pays non établi dans la noticeÉtablissement de santé
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Fujian Medical University Department of Hepatobiliary Surgery pays non établi dans la noticeUniversité ou école supérieure
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Union Hospital pays non établi dans la noticeÉtablissement de santé
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Wuhan General Hospital of Guangzhou pays non établi dans la noticeÉtablissement de santé
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General Hospital of Central Theater Command Department of General Surgery pays non établi dans la noticeÉtablissement de santé
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Wuhan University Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Zhongnan Hospital of Wuhan University pays non établi dans la noticeÉtablissement de santé
Tongji Hospital, Department of Hepatic Surgery — Huazhong University of Science and Technology et Department of Ultrasound in Medicine — Second Affiliated Hospital of Zhejiang University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.