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Updated: Jan 15, 2026
Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection
Published on: April 11, 2025
Laparoscopic versus open hepatectomy in hepatocellular carcinoma patients with high-risk pathological features: a
Li Qin1, Ying Zhou2, Zhan-Cheng Qiu2
1Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Background:
Hepatocellular carcinoma (HCC) patients with high-risk pathological features, which including microvascular invasion, poor tumor differentiation, and satellite nodules have poor overall survival (OS) and recurrence-free survival (RFS) after hepatectomy. However, for patients with high-risk pathological features, whether the prognoses after laparoscopic (LH) and open hepatectomy (OH) are similar remains unclear.
Methods:
Data from a multicenter database of patients with Barcelona Clinic Liver Cancer stage 0/A HCC and high-risk pathological features who underwent hepatectomy from 2014 to 2023 were reviewed (n = 985). The OS, RFS, and incidence of textbook outcome (TO) achievement of patients after LH versus OH were compared.
Results:
After propensity score matching (PSM), the TO rate in the LH group (75.8%) was higher than that in the OH group (67.7%; P = 0.041). Logistic analysis suggested that OH was an independent risk factor associated with non-TO (OR = 1.813, 95% CI = 1.306-2.517; P < 0.001). There were no differences between the two groups in terms of OS (5-year OS, LH:55.6% vs. OH:55.5%; P = 0.334) or RFS (5-year RFS, LH:39.6% vs. OH:36.4%; P = 0.116) after PSM. Subgroup analysis also suggested both the OS and RFS rates of patients who underwent LH and OH were similar in HCC patients with 1, 2, or 3 high-risk pathological features. Multivariate analysis revealed that the number of high-risk pathological features was independently associated with both OS (1 for reference; 2: HR = 1.510, 95%CI = 1.189-1.918, P < 0.001; 3: HR = 2.072, 95%CI = 1.175-3.651, P = 0.012) and RFS (1 for reference; 2: HR = 1.443, 95%CI = 1.187-1.754, P < 0.001; 3: HR = 1.850, 95%CI = 1.131-3.027, P = 0.014), whereas the surgical approach was not.
Conclusion:
For patients with high-risk pathological features, LH was associated with better TO achievement without compromising both the OS and RFS. These findings suggest that LH is also suitable for HCC patients at high risk of recurrence.
