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Page 4 of 15 Kato et al. Hepatoma Res 2021;7:10 I http://dx.doi.org/10.20517/2394-5079.2020.129

Table 2. Types of RLR for HCC
Types of liver resection n = 57
Anatomic liver resection (AR) n = 23
(Extended) right hemihepatectomy 2
(Extended) left hemihepatectomy 1
(Extended) right anterior sectionectomy 2
(Extended) right posterior sectionectomy 3
Left lateral sectionectomy 2
(Sub)segmentectomy 13
I 1
II 1
IVa 1
V 1
V+VI 1
VI 2
VIII 6
Non-anatomic liver resection (NAR) # n = 34
I 2
II 3
III 6
IV 5
V 4
VI 2
VII 1
VIII 11
#
RLR: robotic liver resection, locations of the largest tumor per case

Tumor characteristics
Table 1 also shows the tumor characteristics of the 57 HCC cases treated with RLR. A total of 90 HCC
nodules were resected, and the median number of resected tumors per case was one. Of the 90 tumors, 41
(46%) were located at S-I, S-VII, or S-VIII, which are generally considered difficult segments in which to
perform conventional LLR. Tumors were located at the segment (S)-I, S-VII, or S-VIII in 31 of the 57 cases
(53%); 65% of these cases were treated with AR and 47% were treated with NAR. The median maximal
size of the resected tumors in each case was 2.1 cm. In 21 of the 57 cases (37%), RLR was conducted
for recurrent HCC. Tumor stages based on the Union for International Cancer Control Tumor, Node,
Metastasis (TNM) classification were IA or IB for 32 cases (56%), II for 19 cases (33%), IIIA or IIIB for 4
cases (7%), and IV A or IV B for 2 cases (4%).

Types of liver resection
Table 2 shows the types of liver resection performed for the 57 RLR cases. Of these, 23 cases (40%) were
treated with AR and 34 were treated with NAR. Twenty-three resections belonged to AR in 22 patients
and 34 resections belonged to NAR in 26 patients. One of the 22 patients underwent AR two times. The 26
patients undergoing NAR included 21 patients who underwent NAR only one time, 4 patients undergoing
NAR multiple times and 1 patient undergoing one NAR and one AR. There were 2 patients who underwent
AR in addition to NAR for multiple tumors in a single operation. These 2 patients were classified into the
AR group.

For 16 of the 23 cases (70%) treated with AR, the liver resections were major (≥ 3 Couinaud’s liver
segments) or anatomic sectionectomies/segmentectomies for tumors located in difficult segments (S-I,
S-VII, or S-VIII). Of note, for two cases (one right hemihepatectomy and one posterior sectionectomy),
portal vein tumor thrombi extending into the right portal vein were extirpated by portal venous resection
and reconstruction.