Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: Comparable Oncologic Outcomes in a Contemporary Cohort

Abstract Liver resection is a curative treatment for selected patients with hepatocellular carcinoma. As laparoscopic techniques have advanced, laparoscopic liver resection has been increasingly used. However, its long-term oncologic adequacy compared with open liver resection remains debated. We retrospectively analyzed patients who underwent liver resection for hepatocellular carcinoma at Pusan National University Hospital between August 2019 and December 2022. Patients were divided into laparoscopic and open liver resection groups. Perioperative outcomes and long-term survival outcomes were compared. In total, 257 patients were included, with 209 undergoing laparoscopic and 48 undergoing open liver resection. Liver function and tumor stage were similar between groups. Estimated blood loss was lower in the laparoscopic group, whereas operative time and hospital stay were comparable. Major postoperative complications were more frequent after open surgery, while 90-day mortality was similar. During follow-up, disease-free and overall survival did not differ between groups. Multivariable analysis showed that oncologic outcomes were associated with tumor-related factors, resection margin status, and liver cirrhosis, but not with surgical approach. Laparoscopic liver resection achieved perioperative and oncologic outcomes comparable to those of open liver resection. It may be considered an acceptable surgical option in appropriately selected patients.