Outcomes of laparoscopic versus open liver resection in patients with large or huge HCC: a multicenter study.

[BACKGROUND] This study aimed to compare both perioperative and oncological outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) for patients with large (5-10 cm) or huge (> 10 cm) hepatocellular carcinoma (HCC).

[METHODS] This study analyzed consecutive patients with large or huge HCC who underwent either LLR or OLR across eight medical centers between January 2015 and December 2021. Clinical data were collected from prospectively maintained databases. To address potential selection bias inherent in retrospective studies, we performed 1:1 propensity score matching (PSM) analysis.

[RESULTS] We enrolled 560 patients undergoing OLR and 421 patients undergoing LLR based on predefined inclusion criteria. After PSM (369 patients per group), the LLR group demonstrated superior perioperative outcomes compared to the OLR group, including significantly reduced operative duration, decreased intraoperative blood loss, and shorter hospitalization. Long-term oncological outcomes were comparable between approaches, with no significant differences in overall survival (OS) or recurrence-free survival (RFS). Multivariate Cox regression identified several independent prognostic factors for both OS and RFS: serum alpha-fetoprotein > 400 ng/mL, tumor size (both 5-10 cm and > 10 cm), multifocal disease, and microvascular invasion. Subgroup analyses confirmed the advantages of LLR across tumor size categories. For large HCC, LLR patients exhibited significantly less blood loss and shorter hospital stays. Similarly, in huge HCC, the LLR group showed reduced blood loss and faster recovery compared to the OLR group.

[CONCLUSION] LLR is a safe and effective alternative to OLR for selected patients with large or huge HCC, offering superior perioperative outcomes while maintaining equivalent long-term survival.