Robotic versus laparoscopic liver resection for intrahepatic cholangiocarcinoma: a head-to-head multicenter propensity score-matched analysis

Background: Intrahepatic cholangiocarcinoma (iCCA) is an aggressive primary liver cancer for which surgical resection with lymphadenectomy remains the only potentially curative treatment. Although minimally invasive liver surgery (MILS) provides benefits over open surgery, whether robotic liver resection (RLR) offers advantages over laparoscopic resection (LLR) in oncological adequacy and perioperative outcomes remains unclear. Methods: We retrospectively analyzed consecutive patients with iCCA who underwent MILS in 13 Italian hepatobiliary centers. Patients were stratified by surgical approach (LLR vs RLR) and matched 2:1 by propensity score matching (PSM). Primary endpoints were oncological outcomes and adequacy of lymph node dissection (LND). Secondary endpoints included intraoperative and short-term postoperative outcomes. Results: Overall, 645 patients (468 LLR, 177 RLR) were included; after PSM, 511 patients (334 LLR, 177 RLR) were analyzed. RLR achieved higher R0 resection rates (p = 0.002) and a greater mean lymph node yield (p = 0.001). Overall survival (OS) and disease-free survival (DFS) were comparable between groups. RLR was also associated with lower conversion rates, fewer postoperative complications, and shorter hospital stay. Conclusion: RLR for iCCA is safe and provides advantages in margin status, lymph node dissection, and perioperative outcomes, while long-term oncological outcomes (OS and DFS) are comparable to LLR.