Comparative Study

. 2025 Jun;39(6):3492-3503.

doi: 10.1007/s00464-025-11717-1. Epub 2025 Apr 18.

Minimally invasive versus open liver resection for hepatocellular carcinoma with microvascular invasion: a propensity score-matching study

Zaibo Yang^#^{1

2

3

4

5}, Yewei Zhang^#^{1

3

4

5

6}, Junhao Zheng^{1

3

4

5}, Liye Tao^{1

3

4

5}, Chao Song^{1

3

4

5}, Linghan Gong^{1

3

4

5}, Renan Jin^{7

8

9

10}, Xiao Liang^{11

12

13

14

15

16}

Affiliations

¹ Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
² Department of Radiology, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
³ Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China.
⁴ Zhejiang University Cancer Center, Hangzhou, 310058, China.
⁵ Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China.
⁶ School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, China.
⁷ Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China. jason198508@zju.edu.cn.
⁸ Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China. jason198508@zju.edu.cn.
⁹ Zhejiang University Cancer Center, Hangzhou, 310058, China. jason198508@zju.edu.cn.
¹⁰ Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China. jason198508@zju.edu.cn.
¹¹ Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China. srrshlx@zju.edu.cn.
¹² Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China. srrshlx@zju.edu.cn.
¹³ Zhejiang University Cancer Center, Hangzhou, 310058, China. srrshlx@zju.edu.cn.
¹⁴ Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China. srrshlx@zju.edu.cn.
¹⁵ School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, China. srrshlx@zju.edu.cn.
¹⁶ School of Basic Medical Sciences and Forensic Medicine, Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China. srrshlx@zju.edu.cn.

^# Contributed equally.

PMID: 40251314
DOI: 10.1007/s00464-025-11717-1

Comparative Study

Minimally invasive versus open liver resection for hepatocellular carcinoma with microvascular invasion: a propensity score-matching study

Zaibo Yang et al. Surg Endosc. 2025 Jun.

. 2025 Jun;39(6):3492-3503.

doi: 10.1007/s00464-025-11717-1. Epub 2025 Apr 18.

Authors

Affiliations

¹ Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China.
² Department of Radiology, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
³ Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China.
⁴ Zhejiang University Cancer Center, Hangzhou, 310058, China.
⁵ Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China.
⁶ School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, China.
⁷ Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China. jason198508@zju.edu.cn.
⁸ Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China. jason198508@zju.edu.cn.
⁹ Zhejiang University Cancer Center, Hangzhou, 310058, China. jason198508@zju.edu.cn.
¹⁰ Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China. jason198508@zju.edu.cn.
¹¹ Zhejiang Key Laboratory of Multi-Omics Precision Diagnosis and Treatment of Liver Diseases, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China. srrshlx@zju.edu.cn.
¹² Zhejiang Minimal Invasive Diagnosis and Treatment Technology Research Center of Severe Hepatobiliary Disease, Zhejiang Research and Development Engineering Laboratory of Minimally Invasive Technology and Equipment, Hangzhou, 310016, China. srrshlx@zju.edu.cn.
¹³ Zhejiang University Cancer Center, Hangzhou, 310058, China. srrshlx@zju.edu.cn.
¹⁴ Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China. srrshlx@zju.edu.cn.
¹⁵ School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, China. srrshlx@zju.edu.cn.
¹⁶ School of Basic Medical Sciences and Forensic Medicine, Hangzhou Medical College, Hangzhou, 310000, Zhejiang, China. srrshlx@zju.edu.cn.

^# Contributed equally.

PMID: 40251314
DOI: 10.1007/s00464-025-11717-1

Abstract

Background: Microvascular invasion (MVI) is one of the major risk factors for postoperative recurrence of HCC. For HCC patients with MVI, few studies have examined the differences in prognosis between minimally invasive and open liver resection.

Materials and methods: A total of 171 HCC patients with MVI who underwent curative-intent hepatectomy from September 2017 to October 2022 at Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, were enrolled in this study. Patients were categorized into minimally invasive liver resection (MILR) group (Robotic or laparoscopic) and open liver resection (OLR) group. In order to balance the baseline characteristics between the two groups, 1:4 propensity score matching (PSM) was performed on the two groups. The survival parameters and perioperative parameters were compared between the two groups before and after PSM, respectively.

Results: There was no significant difference in Recurrence Free Survival (RFS) and Overall Survival (OS) between the two groups before and after PSM. Subgroup analysis showed that there were no significant differences in OS and RFS between the two groups regarding anatomical resection, IWATE difficulty score, surgical margins, and postoperative adjuvant therapy. Perioperative parameters and the rate of major postoperative complications were comparable between the two groups.

Conclusion: Minimally invasive approach can provide a comparable long-term survival result compared with conventional open approach for patients with HCC associated with MVI.

Keywords: Hepatocellular carcinoma; Microvascular invasion; Minimally invasive liver resection.

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Conflict of interest statement

Declarations. Disclosures: Zaibo Yang, Yewei Zhang, Junhao Zheng, Liye Tao, Chao Song, Linghan Gong, Renan Jin, and Xiao Liang have no conflict of interest to disclose.

References

1. Xia Y, Yang T, Wang K (2021) Chinese expert consensus on the prevention and management of recurrent hepatocellular carcinoma after hepatic resection (2020 edition). Chinese Journal of Practical Surgery 41: 20–30.
1. Gouw AS, Balabaud C, Kusano H, Todo S, Ichida T, Kojiro M (2011) Markers for microvascular invasion in hepatocellular carcinoma: where do we stand? Liver Trans 17(Suppl 2):S72-80 - DOI
1. Lim KC, Chow PK, Allen JC, Chia GS, Lim M, Cheow PC, Chung AY, Ooi LL, Tan SB (2011) Microvascular invasion is a better predictor of tumor recurrence and overall survival following surgical resection for hepatocellular carcinoma compared to the Milan criteria. Ann Surg 254:108–113 - DOI - PubMed
1. Rodríguez-Perálvarez M, Luong TV, Andreana L, Meyer T, Dhillon AP, Burroughs AK (2013) A systematic review of microvascular invasion in hepatocellular carcinoma: diagnostic and prognostic variability. Ann Surg Oncol 20:325–339 - DOI - PubMed
1. Chen ZH, Zhang XP, Wang H, Chai ZT, Sun JX, Guo WX, Shi J, Cheng SQ (2019) Effect of microvascular invasion on the postoperative long-term prognosis of solitary small HCC: a systematic review and meta-analysis. HPB (Oxford) 21:935–944 - DOI - PubMed

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Minimally invasive versus open liver resection for hepatocellular carcinoma with microvascular invasion: a propensity score-matching study

Affiliations

Minimally invasive versus open liver resection for hepatocellular carcinoma with microvascular invasion: a propensity score-matching study

Authors

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Abstract

Conflict of interest statement

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