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Background: Robotic hepatectomy (RH) is currently widely accepted and it is associated with some benefits when compared to open hepatectomy (OH). However, whether such benefits can still be achieved for patients with large hepatocellular carcinoma (HCC) remain unclear. This study aimed to evaluate the short-term and long-term outcomes of patients undergoing RH or OH. Methods: Perioperative and survival data from patients with large HCC who underwent RH or OH between January 2010 and December 2020 were collected from eight centres. Propensity score matching (PSM) was performed to minimise potential biases. Results: Using predefined inclusion criteria, 797 patients who underwent OH and 309 patients who underwent RH were enroled in this study. After PSM, 280 patients in the robotic group had shorter operative time (median 181 vs. 201 min, P <0.001), lower estimated blood loss (median 200 vs. 400 ml, P< 0.001), and shorter postoperative length of stay (median 6 vs. 9 days, P<0.001) than 465 patients in the open group. There were no significant differences between the two groups in overall survival and recurrencefree survival. Cox analysis showed AFP greater than 400 ng/ml, tumour size greater than 10 cm, and microvascular invasion were independent risk factors for overall survival and recurrence-free survival. After PSM, subgroup analysis showed that patients with a huge HCC (diameter > 10 cm) who underwent RH had significantly lower estimated blood loss (median 200.0 vs. 500.0 min, P<0.001), and shorter length of stay (median 7 vs. 10 days, P <0.001) than those who underwent OH. Conclusion: Safety and feasibility of RH and OH for patients with large HCC were comparable. RH resulted in similar long-term survival outcomes as OH. [ABSTRACT FROM AUTHOR]

Background: Microvascular invasion (MVI) is a risk factor for postoperative survival outcomes for patients with hepatocellular carcinoma (HCC) after hepatectomy. This study aimed to evaluate the impact of anatomical resection (AR) versus nonanatomical resection (NAR) combined with resection margin (RM) (narrow RM <1 cmvs. wide RM =1 cm) on long-term prognosis in hepatitis B virus-related HCC patients with MVI. Materials and methods: Data from multicenters on HCC patients with MVI who underwent hepatectomy was analyzed retrospectively. Propensity score matching analysis was performed in these patients. Results: The 1965 enrolled patients were divided into four groups: AR with wide RM (n= 715), AR with narrow RM (n =387), NAR with wide RM (n= 568), and NAR with narrow RM (n =295). Narrow RM (P< 0.001) and NAR (P< 0.001) were independent risk factors for both overall survival and recurrence-free survival in these patients based on multivariate analyses. For patients in both the AR and NAR groups, wide RM resulted in significantly lower operative margin recurrence rates than those patients in the narrow RM groups after propensity score matching (P =0.002 and 0.001). Patients in the AR with wide RM group had significantly the best median overall survival (78.9 vs. 51.5 vs. 48.0 vs. 36.7 months, P <0.001) and recurrence-free survival (23.6 vs. 14.8 vs. 17.8 vs. 9.0 months, P<0.001) than those in the AR with narrow RM, NAR with wide RM or with narrow RM groups, respectively. Conclusions: If technically feasible and safe, AR combined with wide RM should be the recommended therapeutic strategy for HCC patients who are estimated preoperatively with a high risk of MVI. [ABSTRACT FROM AUTHOR]