Evaluating robotic vs. laparoscopic liver resection for BCLC stage 0–I hepatocellular carcinoma: A meta-analysis of propensity score-matched studies on perioperative outcomes.

534 Background: Liver resection is a key treatment for hepatocellular carcinoma (HCC). Robotic liver resection (RLR) offers potential advantages in precision and minimally invasive surgery, but its superiority over laparoscopic liver resection (LLR) remains unclear due to variations in study design and patient selection. This meta-analysis provides a propensity score-matched comparison of perioperative outcomes between RLR and LLR for HCC. Methods: A systematic search of PubMed, Scopus, and Cochrane identified 520 records, of which five multicenter propensity score-matched cohort studies (1,171 patients: 348 RLR, 823 LLR) were included. Meta-analysis compared perioperative outcomes, with evidence quality assessed by GRADE and study quality evaluated using the Newcastle-Ottawa Scale, showing good methodological rigor and minimal bias. Results: In the meta-analysis, intraoperative outcomes indicated that robotic liver resection was associated with significantly longer operative times compared to laparoscopic procedures (MD: −35.15 minutes, 95% CI: −64.90 to −5.39; p = 0.02), with moderate heterogeneity (I² = 38%). No significant difference was observed in intraoperative blood transfusion requirements (RR: 1.50, 95% CI: 0.41–5.47; p = 0.54) or bile leak rates (RR: 2.11, 95% CI: 0.59–7.52; p = 0.25). Postoperative outcomes showed that robotic resection had a significantly higher rate of 30-day morbidity compared to laparoscopic resection (RR: 1.59, 95% CI: 1.04–2.42; p = 0.03), but there was no significant difference in 90-day mortality (RR: 4.33, 95% CI: 0.84–22.41; p = 0.08). Regarding hospital stay, there was no notable difference in length between the two groups (MD: −0.19 days, 95% CI: −2.42 to 2.05; p = 0.87), although high heterogeneity was present (I² = 95%). Lastly, conversion to open surgery rates were similar between the groups (RR: 1.22, 95% CI: 0.42–3.59; p = 0.71). Conclusions: Robotic and laparoscopic liver resection show comparable outcomes for HCC, with no differences in mortality or conversion rates. RLR is associated with longer operative times and slightly higher short-term morbidity. Evidence quality remains low, highlighting the need for well-designed randomized trials to guide clinical decisions.