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Background <p>Hepatocellular carcinoma (HCC) patients with high-risk pathological features, which including microvascular invasion, poor tumor differentiation, and satellite nodules have poor overall survival (OS) and recurrence-free survival (RFS) after hepatectomy. However, for patients with high-risk pathological features, whether the prognoses after laparoscopic (LH) and open hepatectomy (OH) are similar remains unclear.</p> Methods <p>Data from a multicenter database of patients with Barcelona Clinic Liver Cancer stage 0/A HCC and high-risk pathological features who underwent hepatectomy from 2014 to 2023 were reviewed (<i>n</i> = 985). The OS, RFS, and incidence of textbook outcome (TO) achievement of patients after LH versus OH were compared.</p> Results <p>After propensity score matching (PSM), the TO rate in the LH group (75.8%) was higher than that in the OH group (67.7%; <i>P</i> = 0.041). Logistic analysis suggested that OH was an independent risk factor associated with non-TO (<i>OR</i> = 1.813, 95% CI = 1.306–2.517; <i>P</i> &lt; 0.001). There were no differences between the two groups in terms of OS (5-year OS, LH:55.6% vs. OH:55.5%; <i>P</i> = 0.334) or RFS (5-year RFS, LH:39.6% vs. OH:36.4%; <i>P</i> = 0.116) after PSM. Subgroup analysis also suggested both the OS and RFS rates of patients who underwent LH and OH were similar in HCC patients with 1, 2, or 3 high-risk pathological features. Multivariate analysis revealed that the number of high-risk pathological features was independently associated with both OS (1 for reference; 2: <i>HR</i> = 1.510, 95%CI = 1.189–1.918, <i>P</i> &lt; 0.001; 3: HR = 2.072, 95%CI = 1.175–3.651, <i>P</i> = 0.012) and RFS (1 for reference; 2: HR = 1.443, 95%CI = 1.187–1.754, <i>P</i> &lt; 0.001; 3: HR = 1.850, 95%CI = 1.131–3.027, <i>P</i> = 0.014), whereas the surgical approach was not.</p> Conclusion <p>For patients with high-risk pathological features, LH was associated with better TO achievement without compromising both the OS and RFS. These findings suggest that LH is also suitable for HCC patients at high risk of recurrence.</p>

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Laparoscopic versus open hepatectomy in hepatocellular carcinoma patients with high-risk pathological features: a multicenter propensity score-matched study

  • 期刊论文

  • 发表日期：

    2025年10月13日

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  • Li Qin,
  • Ying Zhou,
  • Zhan-Cheng Qiu,
  • Ting-Hao Cheng,
  • Yu Zhang,
  • Fei Xie,
  • Shu-Sheng Leng,
  • Zheng-Xia Wang,
  • Jun-Long Dai,
  • Tian-Fu Wen,
  • Chuan Li

摘要

Background

Hepatocellular carcinoma (HCC) patients with high-risk pathological features, which including microvascular invasion, poor tumor differentiation, and satellite nodules have poor overall survival (OS) and recurrence-free survival (RFS) after hepatectomy. However, for patients with high-risk pathological features, whether the prognoses after laparoscopic (LH) and open hepatectomy (OH) are similar remains unclear.

Methods

Data from a multicenter database of patients with Barcelona Clinic Liver Cancer stage 0/A HCC and high-risk pathological features who underwent hepatectomy from 2014 to 2023 were reviewed (n = 985). The OS, RFS, and incidence of textbook outcome (TO) achievement of patients after LH versus OH were compared.

Results

After propensity score matching (PSM), the TO rate in the LH group (75.8%) was higher than that in the OH group (67.7%; P = 0.041). Logistic analysis suggested that OH was an independent risk factor associated with non-TO (OR = 1.813, 95% CI = 1.306–2.517; P < 0.001). There were no differences between the two groups in terms of OS (5-year OS, LH:55.6% vs. OH:55.5%; P = 0.334) or RFS (5-year RFS, LH:39.6% vs. OH:36.4%; P = 0.116) after PSM. Subgroup analysis also suggested both the OS and RFS rates of patients who underwent LH and OH were similar in HCC patients with 1, 2, or 3 high-risk pathological features. Multivariate analysis revealed that the number of high-risk pathological features was independently associated with both OS (1 for reference; 2: HR = 1.510, 95%CI = 1.189–1.918, P < 0.001; 3: HR = 2.072, 95%CI = 1.175–3.651, P = 0.012) and RFS (1 for reference; 2: HR = 1.443, 95%CI = 1.187–1.754, P < 0.001; 3: HR = 1.850, 95%CI = 1.131–3.027, P = 0.014), whereas the surgical approach was not.

Conclusion

For patients with high-risk pathological features, LH was associated with better TO achievement without compromising both the OS and RFS. These findings suggest that LH is also suitable for HCC patients at high risk of recurrence.