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

Background/Aim: Minimally invasive liver resection (MILR) of the posterosuperior segments (segments 7 and 8) for hepatocellular carcinoma (HCC) remains technically challenging. This study aimed to compare the perioperative and oncological outcomes between MILR and open liver resection (OLR) using propensity score matching. Patients and Methods: A total of 157 consecutive patients underwent liver resection for HCC located in segments 7 and/or 8 at our institution between January 2010 and February 2026 [80 MILR (58 laparoscopic and 22 robotic) and 77 OLR]. After propensity score matching, each group included 39 patients. Perioperative and long-term oncological outcomes were retrospectively analyzed. Results: None of the patients in the MILR group required conversion to open surgery. The MILR group showed significantly lower intraoperative blood loss (55 vs. 330 ml; p<0.0001), lower transfusion rate (0% vs. 18%; p=0.0056), shorter operative time (288 vs. 338 min; p=0.0179), lower postoperative morbidity (0% vs. 33.3%; p<0.0001), and shorter postoperative hospital stay (8 vs. 15 days; p<0.0001) than the OLR cohort. The 1-, 3-, and 5-year overall survival rates were 100%, 96.2%, and 90.1% in the MILR group and 100%, 91.2%, and 86.0% in the OLR group, respectively (p=0.6579). The corresponding recurrence-free survival rates were 100%, 69.1%, and 41.9% in the MILR group and 81.2%, 47.6%, and 44.6% in the OLR group, respectively (p=0.1491). Conclusion: MILR for HCC involving the posterosuperior segments is safe and feasible, providing superior perioperative outcomes while maintaining oncological outcomes comparable to those of OLR. These findings support the use of minimally invasive approaches for carefully selected patients.