Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

SIMPLE SUMMARY: Patients newly diagnosed with a single hepatocellular carcinoma (HCC) smaller than 3 cm that underwent robotic liver resection (RLR) benefit from a significantly higher potential of cure and tumor-related free survival compared to those that underwent percutaneous ablation (PA), with comparable incidence of morbidity. Notably, the 20.8% incidence of satellitosis in the RLR group confirms that PA patients are at higher risk to obtain a not-radical treatment and, therefore, are more likely to need repeated treatments, which actually doubles the risk of morbidity in the long term. Therefore, therapeutic algorithms as well as down-staging protocols for HCC can be implemented with robotic approaches in high volume centers with extensive experience in the field of hepato-biliary surgery and minimally invasive approaches, to offer more opportunities to those patients. ABSTRACT: Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short- and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.