Long-term Outcomes of Open Versus Minimally Invasive Hepatectomy for Hepatocellular Carcinoma: A Single-Center Experience in the USA

Introduction: Surgical resection is the treatment of choice for hepatocellular carcinoma (HCC). With advances in technology, minimally invasive surgery has become the standard of care in most fields of general surgery, including hepatectomy. We compared the clinicopathologic features and long-term prognosis of HCC between open hepatectomy (OH) and minimally invasive hepatectomy (MIH). Methods: 134 patients who underwent OH (108) and MIH (26) from 2010 to 2020 for HCC were enrolled. Clinicopathologic features were retrospectively compared between the two groups. Overall survival (OS) and disease-free survival (DFS) were investigated. Results: Among 26 cases of MIH, 13 patients underwent robotic surgery and 13 patients underwent laparoscopic surgery. Significant differences between OH and MIH groups include: age (mean 60.1years, 66.9years; p = 0.015), resection area (major hepatectomy 56.5%, 7.7%; p <0.001), operation time (337min, 267min; p = 0.013), transfusion volume (268ml, 107ml; p 0.048), tumor number (1.8 [SD 1.24], 1.04 [SD 0.45]; p<0.001), and length of stay (mean 8.7days [SD 5.7], 5.69days [SD 2.9]; p <0.010). However, there were no statistically significant differences in tumor size, microvascular invasion, macrovascular invasion, cirrhosis, and R0 resection. The overall survival rates at 1, 3, and 5 years between OH and MIH groups were 79.3%, 64.2%, 47.9% vs. 79.7%, 52.9%, 44.1%, respectively (p = 0.484). The disease-free survival rates at 1, 3, and 5 years between two groups were 70.5%, 48.3%, 40.0% vs. 73.2%, 53.4%, 40.0%, respectively (p 0.729). Conclusion: Minimally invasive surgery for HCC showed a safe and similar long-term outcome compared to open hepatectomy.