Minimally Invasive Versus Open Liver Resection for HCC in the Posterosuperior Segments: A Propensity Score-matched...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Minimally invasive surgery

Background:

• Hepatocellular carcinoma (HCC) in the posterosuperior segments (7 and 8) presents surgical challenges.
• Minimally invasive liver resection (MILR) is increasingly adopted, but its efficacy for these specific HCC locations needs evaluation.
• Open liver resection (OLR) is the traditional approach for these resections.

Purpose of the Study:

• To compare perioperative and oncological outcomes of MILR versus OLR for HCC in posterosuperior liver segments.
• To evaluate the safety and feasibility of MILR in this challenging anatomical location.
• To assess long-term survival and recurrence rates between the two surgical approaches.

Main Methods:

• Retrospective analysis of 157 patients with HCC in segments 7/8 (80 MILR, 77 OLR).
• Propensity score matching created comparable groups of 39 patients each (MILR vs. OLR).
• Outcomes analyzed included intraoperative blood loss, transfusion rates, operative time, morbidity, hospital stay, overall survival, and recurrence-free survival.

Main Results:

• MILR group had significantly less blood loss (55 vs. 330 ml), lower transfusion rates (0% vs. 18%), shorter operative times (288 vs. 338 min), and reduced postoperative morbidity (0% vs. 33.3%).
• MILR patients experienced shorter hospital stays (8 vs. 15 days).
• No significant differences were observed in 1-, 3-, and 5-year overall survival and recurrence-free survival rates between MILR and OLR groups.

Conclusions:

• MILR for HCC in posterosuperior liver segments is a safe and feasible alternative to OLR.
• MILR offers significant advantages in perioperative outcomes without compromising long-term oncological results.
• These findings support the adoption of MILR for carefully selected patients undergoing resection for HCC in these segments.