Laparoscopic versus open liver resection following transarterial radioembolization for hepatocellular carcinoma: a...

This study was performed to compare perioperative and oncologic outcomes between laparoscopic and open liver resection following transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC). TARE is increasingly used as a bridge therapy for HCC when immediate resection is not feasible. However, the safety and efficacy of subsequent laparoscopic liver resection compared to open surgery remain unclear.

We retrospectively analyzed 65 patients who underwent liver resection after TARE for HCC between 2012 and 2023 at a single high-volume center. Propensity score matching based on age, sex, tumor size, and tumor markers (AFP, PIVKA-II) yielded 18 matched pairs for laparoscopic and open surgery.

The laparoscopic group demonstrated shorter time from TARE to operation (99.7 days vs. 166.9 days, P = 0.04) and reduced hospital stay (11.2 days vs. 15.6 days, P = 0.04). Operative outcomes were comparable between groups, including operative time (243.9 minutes vs. 210.0 minutes, P = 0.13) and blood loss (438.9 mL vs. 775.0 mL, P = 0.12). Major complications (Clavien-Dindo grade ≥III) occurred in 11.1% of laparoscopic vs. 27.8% of open cases (P = 0.40). Recurrence rates (55.6% vs. 44.4%, P = 0.51), overall survival (56.5 months vs. 44.7 months, P = 0.10), and progression-free survival (28.1 months vs. 32.4 months, P = 0.815) were similar between groups.

Laparoscopic liver resection following TARE appears to be a safe and effective approach for selected HCC patients, offering comparable oncologic outcomes to open surgery while achieving shorter hospitalization. These findings support the consideration of minimally invasive approaches in appropriate candidates after TARE at experienced centers.