Laparoscopic Versus Open Liver Resection for Huge (≥10 cm) Hepatocellular Carcinoma: A Single-Center Experience

Introduction: Laparoscopic liver resection (LLR) is increasingly being utilized worldwide for the management of malignant liver tumors, including hepatocellular carcinoma (HCC). However, the role of LLR for huge (≥10 cm) HCCs remains controversial with limited data to date regarding its safety and feasibility. We aimed to compare perioperative and long-term outcomes of LLR and open liver resection (OLR) for huge HCCs. Methods: We conducted a retrospective review of 170 consecutive patients who underwent liver resection for huge HCC from 2010 to 2024. Propensity score matching (PSM) (both 1:1 and 1:2) was performed to account for differences in baseline characteristics between LLR and OLR groups when comparing perioperative and long-term outcomes. Results: A total of 38 patients underwent LLR, of which major hepatectomies were performed in 29 (76.3%) patients, and 132 underwent OLR, of which major hepatectomies were performed in 93 (70.4%) patients. There were 4 (10.5%) open conversions in the LLR cohort. After PSM, both LLR and OLR groups were well-matched for baseline characteristics other than a higher proportion of Institut Mutualiste Montsouris grade 3 procedures in the LLR group. Comparison between perioperative outcomes demonstrated no significant differences in close resection margins (<1 mm), blood transfusion rate, postoperative morbidity, major morbidity, 30-day readmission, postoperative length of stay and 30-day/in-hospital mortality. LLR was associated with lower intraoperative blood loss at the expense of a longer operation time. The 3-year actuarial overall survival rate was 55% in the entire cohort, and there was no significant difference between LLR and OLR. Conclusion: LLR may be safely performed for huge HCCs with comparable perioperative and long-term oncological outcomes.