Thermal ablation in posterosuperior liver segments: Is this an indication to laparoscopic approach?

Backgrounds/Aims: Primary liver tumors such as hepatocellular carcinoma (HCC), and colorectal cancer liver metastases, can be treated with liver thermal ablation (LTA).Current evidence comparing percutaneous LTA (P-LTA) and laparoscopic LTA (L-LTA) is inconclusive, and data on lesions in the posterosuperior (PS) liver segments are scarce.This study aimed to compare early local recurrence rates between percutaneous and laparoscopic thermal ablation, with a focus on PS liver segments.Methods: This single-centre retrospective study included all consecutive patients treated with P-LTA or L-LTA between 2010 and 2024.The primary outcome was early local recurrence (≤ 6 months); secondary outcomes were subgroup analyses of HCC nodules and microwave ablation-treated nodules.Results: The study included 101 nodules in 69 patients.Overall morbidity was higher after L-LTA, whereas chronic liver disease was more common among P-LTA patients.Early local recurrence was significantly lower after L-LTA (7% vs. 25%), and this difference was accentuated in the PS liver segments (4% vs. 33%).Multivariable analysis identified the percutaneous approach and a lesion size > 3 cm as predictors of early local recurrence.Conclusions: L-LTA appears more effective in reducing early local recurrence, particularly in the PS segments, although P-LTA remains less invasive.Prospective multicentre studies are needed to validate these findings.