Beyond non-anatomical resections: Is minimally invasive parenchyma-sparing anatomical hepatectomy the next chapter?

Parenchyma-sparing hepatectomy using minimally invasive techniques is typically performed for peripheral liver lesions by means of non-anatomic liver resection. However, anatomical hepatectomies may be required for technical and biological reasons and can still be performed in a parenchyma-sparing approach such as (sub)segmentectomies or sectionectomies. Given limited evidence regarding outcomes of minimally invasive anatomical liver resections, the aim of the study was to compare parenchyma-sparing (PAR) with non-parenchyma-sparing (NPAR) anatomical liver resection.

From 2020 to 2025 we identified consecutive patients who had minimally invasive anatomical liver resections at our institution. Perioperative outcomes were compared using univariate and multivariate analyses. A propensity-score analysis was performed to match PAR and NPAR groups.

Of 228 patients with minimally invasive anatomical liver resections, a total of 158 patients underwent parenchyma sparing and 70 patients a non-parenchyma sparing liver resection. The PAR group showed a shorter median operating time (213 vs. 280 min, P = 0.002), lower median blood loss (400 vs. 500 ml, P = 0.003), and a shorter median hospital stay (5 vs. 6 days, P = 0.004) compared to the NPAR group. There were no differences in posthepatectomy bile leakage, posthepatectomy hemorrhage and posthepatectomy liver failure between the two groups, however, there were less severe complications in the PAR group (12% vs. 30%, P = 0.024).

Minimally invasive parenchyma-sparing anatomical hepatectomy is associated with improved perioperative outcomes compared to non-parenchyma-sparing resections.