Standardized Technique for Minimally Invasive Right Posterior Sectionectomy for Hepatocellular Carcinoma: A Propensity Score-matched Study

Minimally invasive right posterior sectionectomy (MIRPS) for hepatocellular carcinoma (HCC) is a technically demanding anatomical liver resection procedure, characterized by restricted visibility and complex hemostatic control. Its effectiveness, compared to that of open surgery, is uncertain. Therefore, this study aimed to compare the perioperative and long-term oncological outcomes of MIRPS and open right posterior sectionectomy (ORPS) for HCC. Data of 122 consecutive patients, who underwent right posterior sectionectomy as initial treatment for primary HCC from January 2010 to February 2025, were retrospectively analyzed. Patients were allocated to MIRPS and ORPS groups, and surgical outcomes were compared using 1:1 propensity score matching (PSM). After PSM, the MIRPS and ORPS groups comprised 35 patients each. No procedures in the MIRPS group required conversion to open surgery. The MIRPS group demonstrated significantly lower blood loss (119 vs. 548 ml; p<0.0001), reduced transfusion rates (0% vs. 11.4%; p=0.0394), shorter operative durations (356 vs. 396 min; p=0.0376), lower postoperative morbidity rates (0% vs. 28.6%; p=0.0006), and shorter postoperative hospital stays (9 vs. 15 days; p<0.0001) compared to the ORPS group. The 1-, 3-, and 5-year overall survival rates were 100%, 96.3%, and 96.3% in the MIRPS group and 100%, 91.2%, and 87.9%, in the ORPS group (p=0.3026), respectively. The 1-, 3-, and 5-year recurrence-free survival rates were 88.5%, 77.1%, and 71.6% in the MIRPS group and 85.7%, 65.4%, and 65.4%, in the ORPS group (p=0.5631), respectively. MIRPS reduced perioperative complications, shortened postoperative hospital stay, and achieved recurrence-free and overall survival rates comparable to those of ORPS. Our standardized MIRPS procedure for HCC is considered safe, feasible, and oncologically acceptable for use in selected patients.