Background: There is still poor evidence about the safety and feasibility of minimally invasive liver surgery (MILS) for huge (> 10 cm) hepatocellular carcinomas (HCC). The aim of this study was to assess the short- and long- term outcomes of MILS versus open liver resection (OLR) for patients with huge HCC.
Methods: Data regarding all consecutive patients undergoing liver resection for huge HCC were retrospectively collected from Asian (South Korean) and European (Italian and French) referral HPB centers. The cases were propensity score matched for age, center, extent of the resection, tumor size, and tumor number.
Results: A total of 198 patients were included in the study. Before matching there were statistically significant differences in tumor size (p < 0.01) and rates of major hepatectomies performed (p = 0.03). After PSM two cohorts of 39 patients were obtained, with no statistically significant differences in all the compared preoperative characteristics. No significant differences were found in terms of major complications, in-hospital mortality, and operative time, between the matched cohorts. The median length of hospital stay was significantly lower after MILS (7 vs. 10 days, p < 0.01), as well as the median intraoperative estimated blood loss (500 ml vs 800 ml, respectively; p = 0.02) and the rates of intraoperative transfusions (25.6% vs 48.7%, respectively; p = 0.03). After a median follow-up of 52 months, there were no significant differences between OLR and MILS in median OS (44 vs. 93.6 months, respectively; p = 0.07). Median DFS was improved after MILS (49.8 vs. 7 months, respectively; p < 0.01).
Conclusion: MILS for huge HCC can be safe and effective in selected cases in referral centers, being able to reduce intraoperative blood loss, and to shorten median hospital stay.
Keywords: Hepatocellular carcinoma; Huge hepatocellular carcinoma; Minimally invasive liver surgery.
© 2026. The Author(s).