Laparoscopic versus open sectionectomy and bisectionectomy for hepatocellular carcinoma: a propensity score-matched analysis of short- and long-term outcomes.

BACKGROUND: This study aimed to compare short- and long-term outcomes of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) in patients with HCC who underwent sectionectomies or bisectionectomies. METHODS: From 2018 to 2023, HCC patients who underwent a sectionectomy or bisectionectomy were retrospectively analyzed. Propensity score matching (PSM) was used to assess the association of operative approaches with short- and long-term outcomes. RESULTS: Among 112 patients with HCC, 49 (43.8%) and 63 (56.2%) underwent LH and OH, respectively. Compared with OH, LH was respectively associated with lower blood loss (844 vs. 307 mL, p < 0.001), shorter hospital stay (20 vs. 15 days, p = 0.010), lower rates of severe postoperative complications (33% vs. 14%, p = 0.032) and overall infections (40% vs. 20%, p = 0.029), and organ/space surgical site infections (30% vs. 10%, p = 0.011). After PSM, LH remained superior regarding blood loss, hospital stay, severe postoperative complications, overall infections, and organ/space SSIs (323 mL, 15 days, 17, 19, and 11% vs. 762 mL, 22 days, 39, 47, and 36%, respectively). The patients undergoing LH had lower C-reactive protein (CRP) levels (p = 0.006), longer prothrombin time (p = 0.012), and higher cholinesterase levels (p = 0.046) than the patients undergoing OH throughout the postoperative period. The differences between the 5-year OS (57.1% vs. 46.7%, p = 0.685) and RFS (34.9% vs. 26.8%, p = 0.475) rates of the respective LH and OH patients were not significant. CONCLUSIONS: Laparoscopic sectionectomies and bisectionectomies for patients with HCC are feasible and safe, with better short-term outcomes than open sectionectomies and bisectionectomies, and provide similar long-term outcomes.