Outcomes of robotic liver resection and intraoperative radiofrequency ablation for hepatocellular carcinoma in posterior segments VII and VIII

doi:10.4240/wjgs.v17.i12.113940

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Dec 27, 2025 (publication date) through Dec 25, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Dec 27, 2025; 17(12): 113940
Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.113940

Outcomes of robotic liver resection and intraoperative radiofrequency ablation for hepatocellular carcinoma in posterior segments VII and VIII

Cheng-Ming Peng, Shao-Chieh Lin, Yung-Yin Cheng, Teng-Chieh Cheng, Ching-Lung Hsieh, Chia-Hong Hsieh, Mei-Fang Hsieh, Chun-Han Liao, Ming-Cheng Liu, Yi-Jui Liu

Cheng-Ming Peng, Ching-Lung Hsieh, Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan

Cheng-Ming Peng, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan

Shao-Chieh Lin, Yung-Yin Cheng, Chia-Hong Hsieh, Mei-Fang Hsieh, Chun-Han Liao, Ph.D. Program of Electrical and Communications Engineering, Feng Chia University, Taichung 407, Taiwan

Yung-Yin Cheng, Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan

Teng-Chieh Cheng, Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan

Ching-Lung Hsieh, Department of Computer Science and Information Engineering, Feng Chia University, Taichung 40724, Taiwan

Chia-Hong Hsieh, Department of Radiology, Taichung Armed Forces General Hospital, Taichung 411, Taiwan

Mei-Fang Hsieh, Chun-Han Liao, Department of Medical Imaging, Changhua Christian Hospital, Changhua 500, Taiwan

Chun-Han Liao, Division of Medical Imaging, Yuanlin Christian Hospital, Changhua 510, Taiwan

Ming-Cheng Liu, Department of Medical Imaging, Taichung Veterans General Hospital, Taichung 407, Taiwan

Yi-Jui Liu, Department of Automatic Control Engineering, Feng Chia University, Taichung 407, Taiwan

Author contributions: Peng CM, Lin SC, and Liu YJ drafted the manuscript; Peng CM and Hsieh CL contributed surgical expertise in hepatocellular carcinoma management; Peng CM and Liu YJ conceived and designed the study and conducted the literature review; Lin SC and Cheng TC collected and organized patient data; Lin SC and Liu YJ performed the statistical analyses; Cheng YY, Hsieh CH, Hsieh MF, Liao CH, and Liu MC provided radiological expertise in hepatocellular carcinoma diagnosis. All authors reviewed, revised, and approved the final version of the manuscript.

Supported by Feng Chia University/Chung Shan Medical University, No. FCU/CSMU 112-001; and Taiwan National Science and Technology Council, No. NSTC 114-2221-E-035-036.

Institutional review board statement: This study was designed as a retrospective review, approved as a completely ethical review by the Institutional Review Board of Chung Shan Medical University Hospital (Approval No. CS1-25119).

Informed consent statement: Approval from the Institutional Review Board of Chung Shan Medical University Hospital was obtained, and the requirement for informed consent was waived.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yi-Jui Liu, PhD, Professor, Department of Automatic Control Engineering, Feng Chia University, No. 100 Wenhwa Road, Seatwen, Taichung 407, Taiwan. erliu@fcu.edu.tw

Received: September 8, 2025
Revised: September 24, 2025
Accepted: October 28, 2025
Published online: December 27, 2025
Processing time: 108 Days and 21.6 Hours

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation (RFA). Robotic-assisted techniques may enhance safety and precision, but comparative evidence remains limited.

AIM

To compare the clinical outcomes of robotic liver resection (R-LR) and robotic intraoperative RFA (RIO-RFA) for HCC located in liver segments VII and VIII.

METHODS

We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo (n = 57) or first recurrent (n = 36). HCC who underwent R-LR or RIO-RFA between 2015 and 2024. Propensity score matching was performed to reduce selection bias. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier curves, log-rank tests, and Cox regression were used to identify prognostic factors for OS and RFS.

RESULTS

In the de novo group, OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching. In contrast, the recurrent group showed significantly improved OS and RFS with R-LR (P = 0.005 and P = 0.012, respectively). Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR, whereas carefully selected low-risk recurrent patients undergoing RIO-RFA (smaller tumors, absence of complications) achieved outcomes comparable to R-LR. Platelet count, tumor size, and postoperative complications constituted key prognostic factors.

CONCLUSION

For HCC in challenging liver segments VII and VIII, R-LR and RIO-RFA achieve comparable outcomes in de novo cases, whereas R-LR confers superior survival in recurrent disease. R-LR should be prioritized for small de novo HCCs and for recurrent disease overall; RIO-RFA may serve as an effective alternative in carefully selected low-risk recurrent patients. Tumor size, platelet count, and postoperative complications are key prognostic indicators to guide individualized treatment.

Keywords: Hepatocellular carcinoma; Robotic liver resection; Radiofrequency ablation; Liver segments VII and VIII; Survival outcomes; Recurrence-free survival

Core Tip: Hepatocellular carcinoma (HCC) located in liver segments VII and VIII presents unique surgical challenges due to their posterior-superior position. This study compared robotic liver resection (R-LR) with robotic intraoperative radiofrequency ablation (RIO-RFA) in groups with de novo and first recurrent HCC. In de novo HCC, survival outcomes were comparable between R-LR and RIO-RFA, whereas R-LR conferred superior overall and recurrence-free survival in recurrent cases. Subgroup analyses identified tumor size, platelet count, and postoperative complications as critical prognostic factors. These findings suggest R-LR should be prioritized, while RIO-RFA may remain an option in carefully selected low-risk patients.