AB043. SOH25_AB_220. Robotic liver resection in patients with cirrhosis: a feasible, safe approach with comparable perioperative and oncological outcomes to minimally invasive liver resections in non-cirrhotic patients
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AB043. SOH25_AB_220. Robotic liver resection in patients with cirrhosis: a feasible, safe approach with comparable perioperative and oncological outcomes to minimally invasive liver resections in non-cirrhotic patients

Conor Mullen, Fungai Dengu, Robert O’Connell, Emir Hoti, Christos Andreou, Silvia Caregari, Sourav Choudary, Tom Gallagher, Fiona Hand

Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland

Background: Robotic liver resection (RLR) provides distinct advantages over other minimally invasive liver surgery (MILS) techniques, including enhanced visualization, improved suturing capabilities, and greater precision in dissection and lymphadenectomy. Despite these benefits, its use has been predominantly restricted to non-cirrhotic patients due to the heightened risk of complications associated with clinically significant portal hypertension (CSPH). This study aimed to compare the outcomes of RLR in patients with and without CSPH performed in a single centre.

Methods: A retrospective analysis was performed on consecutive RLR cases identified from a prospectively maintained database between 2020 and 2024. All procedures were conducted using the Da Vinci Xi robotic platform by one of three specialized robotic hepatopancreatobiliary surgeons. Intraoperative, perioperative, and oncological outcomes were compared between patients with CSPH and those without.

Results: A total of 87 RLRs were analysed, including 21 cases (24.1%) involving CSPH. The primary indications for RLR were hepatocellular carcinoma (28; 32.2%) and colorectal metastases (22; 25.3%), with a median lesion size of 50.2 mm. No significant differences were observed between the CSPH and non-CSPH groups in operative time (P=0.370), blood loss (P=0.903) and post operative complications (P=0.747). Margin free or “R0” resection rates were equivalent between groups (P=1.00). Patients with CSPH experienced a significantly longer length of hospital stay compared to non-CSPH patients (median 5 versus 7 days, P=0.008).

Conclusions: This study demonstrated that RLR in patients with CSPH is feasible and safe, achieving comparable operative and oncological outcomes to RLR in non-cirrhotic patients. The extended hospital stay in the CSPH group reflects the physiological complexity and heightened risk profile of these patients. By expanding access to minimally invasive liver resection for cirrhotic patients, RLR has the potential to facilitate combined treatments and downstaging strategies in oncological resections, ultimately improving survival outcomes.

Keywords: Cirrhosis; Da Vinci system; hepatocellular carcinoma; liver resection; robotic surgery

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab043
Cite this abstract as: Mullen C, Dengu F, O’Connell R, Hoti E, Andreou C, Caregari S, Choudary S, Gallagher T, Hand F. AB043. SOH25_AB_220. Robotic liver resection in patients with cirrhosis: a feasible, safe approach with comparable perioperative and oncological outcomes to minimally invasive liver resections in non-cirrhotic patients. Mesentery Peritoneum 2025;9:AB043.

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