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Lai et al.                                                                                                                                                                                          Robotic hepatectomy for HCC


           Table 3: Nonrandomized comparative studies comparing robotic and laparoscopic minor hepatectomy
                                                                                      Hospital   R0
           Studies               n    Operating  Blood loss  Conversion  Complication  Mortality   stay   resection   Cost
                                      time (min)  (mL)      (%)        (%)      (%)   (days)   (%)
                    [18]
           Berber et al.  (2010)  9 vs. 23  258.5 vs.   136 vs. 155  11.1 vs. 0  11 vs. 17  \  \  \      \
                                        233.6
                      [19]
           Packiam et al.  (2012)  11 vs. 18 175 vs. 188  30 vs. 30  0 vs. 0  27 vs. 0*  0 vs. 0  4 vs. 3*  \  $6,553 vs.
                                                                                                       $4,408*
                  [20]
           Lai et al.  (2013)  33 vs. 33  202.7 vs.   373.4 vs.   \   3 vs. 9  0 vs. 0   \    90.9 vs.   \
                                        133.4*    347.7                                        90.9
                      [21]
           Tranchart et al.  (2014) 28 vs. 28 210 vs. 176  200 vs. 150 14.3 vs. 7.1  17.9 vs. 17.9  0 vs. 0  4.5 vs. 3  \  \
                                       (median)
                 [22]
           Yu et al.  (2014)  13 vs. 17  291.5 vs.   388.5 vs.   0 vs. 0  0 vs. 11.8  0 vs. 0  7.8 vs.   \  $11,475 vs.
                                        240.9*    342.6                                 9.5            $6,762*
                  [23]
           Kim et al.  (2016)  12 vs. 31  337.4 vs.   225 vs. 150   0 vs. 3.2  25 vs. 22.6  0 vs. 0  7 vs. 7  \  $8,183 vs.
                                        216.4*   (median)                                             $5,190 *
                     [24]
           Montalti et al.  (2016)  36 vs. 72 306 vs. 295 415 vs. 437 13.9 vs. 9.7  19.4 vs. 19.4  2.8 vs. 0 6 vs. 4.9  88.9 vs.   \
                                                                                               87.5
                     [25]
           Salloum et al.  (2017)  16 vs. 80 190 vs. 162 247 vs. 206  13 vs. 3  13 vs. 11  0 vs. 1  6 vs. 7  100 vs. 98 €5,522 vs.
                                                                                                       €6,035
           *P < 0.05
           Table 4: Nonrandomized comparative studies comparing robotic and laparoscopic minor and major hepatectomy
                                        Operating  Blood loss  Conversion  Complication  Mortality   Hospital   R0
           Studies                n                                                        stay   resection  Cost
                                        time (min)  (mL)      (%)        (%)       (%)    (days)    (%)
                    [26]
           Tsung et al.  (2014)  57 vs. 114  253 vs.   200 vs. 100  7 vs. 8.8  19.3 vs. 26  0 vs. 1.8  4 vs. 4   95 vs. 92  \
                                          198.5*                                         (median)
           Spampinato et al.  (2014) 25 vs. 25 430 vs. 360 250 vs. 400  4 vs. 4  16 vs. 36  0 vs. 4  8 vs. 7  100 vs. 91  \
                        [27]
           Wu et al.  (2014)    38 vs. 41 380 vs. 227* 325 vs. 173*  5 vs. 12.2  8 vs. 10  0 vs. 0  7.9 vs. 7.2  \  \
                  [28]
           Lee et al. [29]  (2016)  70 vs. 66  251.5 vs.   100 vs. 100  5.7 vs. 12.1  11.4 vs. 4.5  0 vs. 0  5 vs. 5  \  \
                                          215*    (median)
           *P < 0.05
           ONCOLOGICAL OUTCOMES                               rate was 1.6% and the complication rate was 4.4%.
                                                              The two groups had a comparable percentage of
           At present, available survival data about robotic partial   major partial hepatectomy (41.9% vs. 39.5%) and liver
           hepatectomy for HCC in the literature are limited still.   cirrhosis (45.7% vs. 46.9%). Compared with the open
           Difficult learning curves, adequate resection margins,   group, the robotic group required longer operating
           tumor seeding, metastases of the wounds, and the   times (343 vs. 220 min), shorter hospital stay (7.5
           long-term outcome are the major concerns. No port-  vs. 10.1 days), and lower dosages of postoperative
           site recurrence was reported. However, specific    patient-controlled analgesia (350 vs. 554 ng/kg). The
           survival data in homogenous group of pathology was   3-year disease-free survival of the robotic group was
           very limited. The majority of the papers included deals   comparable with that of the open group (72.2% vs.
           with patients undergoing robotic partial hepatectomy   58.0%), and also similar in the 3-year overall survival
           for different diseases, whereas HCC represent a    (92.6% vs. 93.7%).
           variable (often small) proportion of the total. Therefore,
           a meaningful analysis of survival data for HCC after   Robotic vs. conventional laparoscopic
           robotic surgery was difficult still.               approach for HCC
                                                              In 2013, the short-term survival outcome after robotic
           Robotic vs. open approach for HCC                  partial hepatectomies for 41 consecutive patients with
           In Chen et al. [33] , a total of 183 patients underwent   HCC was reported by Lai et al. [20] . The mean operation
           robotic partial hepatectomy and 275 patients underwent   time and blood loss was 229.4 min and 412.6 mL,
           open partial hepatectomy by the same surgical team   respectively. The R0 resection rate was 93%. The
           between January 2012 and October 2015. Eighty-     hospital mortality and morbidity rates were 0% and
           one newly diagnosed HCC cases in each group were   7.1%, respectively. The mean hospital stay was 6.2
           compared under propensity score matching in a 1:1   days. The 2-year overall and disease-free survival
           ratio. With robotic partial hepatectomy, the conversion   rates were 94% and 74%, respectively. In the subgroup

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