Introduction: The safety and oncological adequacy of laparoscopic liver resections for Gallbladder cancer (GBC) and intrahepatic Cholangiocarcinoma (ICC) have been questioned in the past and many surgeons are hesitant to consider it. This study aimed to compare the latest Mayo clinic experience with laparoscopic and open liver resections for these diseases. Method: Adult Individuals undergoing liver resections for GBC or ICC at Mayo clinic between 01/2016 and 04/2021 were identified. Open cases were frequency-matched to all laparoscopic cases at approximately 2:1 ratio. Demographic, clinical, operative/postoperative details as well as recurrence and survival patterns were abstracted from the institutional database and retrospectively analyzed. Results: Out of an 87 subject’s cohort, 33 underwent laparoscopic and 54 open resections. Median age at resection was 67 years and 60% of subjects were female. Subjects undergoing laparoscopic resections had significantly lower blood loss, higher negative margin resections rates, shorter length of hospital stay, lower number of harvested lymph nodes and were less likely to have major liver resections. Surgery type was not associated with differences in procedure time, tumor size, severe post-operative complications, adjuvant chemotherapy and need for readmission or reoperation (see table). After a median follow-up of 471 days, 35% of subjects experienced disease recurrence and 29% had died. There was no association between type of surgery and risk of recurrence or death. Conclusions: With appropriate patient selection and when done by experienced minimal-invasive HPB surgeons, laparoscopic liver resections for GBC and ICC are safe and offer short-term benefits without compromising oncological outcomes.Tabled 1Open resections (N=54)Laparoscopic resections (N=33)Total (N=87)P- valuePre-operativeMedian age at surgery68.065.067.00.204Sex0.823 Female33 (61.1%)19 (57.6%)52 (59.8%) Male21 (38.9%)14 (42.4%)35 (40.2%)Median BMI28.730.929.00.032ASA score ≥341 (75.9%)26 (78.8%)67 (77.0%)0.800OperativeType of liver resection0.015 Major33 (61.1%)11 (33.3%)44 (50.6%) Minor21 (38.9%)22 (66.7%)43 (49.4%)Median operative time (minutes)203193198.50.972Median estimated blood loss (ml)4752504000.004Post-operativeSevere post-operative complications (Clavien-Dindo score ≥3)17 (31.5%)9 (27.3%)26 (29.9%)0.810Median length of stay (days)6350.003Readmission10 (18.5%)4 (12.1%)14 (16.1%)0.554Reoperation2 (3.7%)1 (3.0%)3 (3.4%)1.000Any systemic adjuvant treatment0.661 Yes28 (51.9%)19 (57.6%)47 (54.0%) No26 (48.1%)14 (42.4%)40 (46.0%)PathologyMedian tumor size (mm)56.536.549.50.063Margins status0.041 Positive7 (13%)0 (0%)7 (8.0%) Negative47 (87.0%)33 (100.0%)80 (92.0%)Number of harvested lymph nodes0.033 08 (14.8%)13 (39.4%)21 (24.1%) 1-524 (44.4%)12 (36.4%)36 (41.4%) 6 or more22 (40.7%)8 (24.2%)30 (34.5%) Open table in a new tab