Histopathologic growth patterns (HGPs) of colorectal liver metastases (CRLM) have emerged as potential prognostic biomarkers, though their clinical significance remains under investigation. The objective is to evaluate the prognostic value of HGPs on recurrence-free survival (RFS) and overall survival (OS) in patients undergoing liver resection for CRLM. This was a retrospective analysis of the OSLO-COMET randomized controlled trial, where 280 patients underwent laparoscopic or open parenchyma-sparing liver resection for CRLM between February 2012 and February 2016. Patients eligible for long-term analysis and with available histological material were included. HGPs were categorized as desmoplastic, pushing, replacement, or mixed, according to international consensus guidelines. Kaplan-Meier and Cox proportional hazards models were used to evaluate associations between HGPs and survival. A total of 239 patients were included. Desmoplastic HGP was present in 43.5% of patients and associated with significantly better outcomes. Median RFS was 31 months for desmoplastic versus 9, 10, and 11 months for replacement, pushing, and mixed groups, respectively (p = 0.002). Five-year OS was 62% for desmoplastic, 59% for replacement, 55% for mixed, and 39% for pushing HGP (p = 0.036). In multivariable analysis, HGP, lymph node status, and extrahepatic disease were independent predictors of RFS. Age, tumor size, ECOG score, and extrahepatic metastasis significantly impacted OS. Replacement, pushing and mixed HGPs were associated with poor RFS, although replacement and mixed patterns showed better OS after treatment of recurrences. Desmoplastic HGP was independently associated with better RFS and OS following resection for CRLM.

Hepatic caudate lobe hemangiomas present unique surgical challenges due to the segment's deep location amidst critical vasculature (IVC, portal vein, hepatic veins). The literature on hepatic caudate lobe hemangiomas remains limited, resulting in a lack of comprehensive understanding and standardized treatment protocols for this condition. By comparing the surgical and perioperative outcomes of robotic versus open complete isolated caudate lobectomy for hemangiomas, this study aims to advance our understanding and management of this disease. This single-center study included 83 patients who underwent complete isolated caudate lobe hemangioma resection. Patients were allocated to two groups: the robotic liver resection group (RLR, n = 33) and the open liver resection group (OLR, n = 50). Demographic characteristics and perioperative outcomes were compared between the two cohorts. Additionally, we explored the risk factors for intraoperative bleeding and conducted a subgroup analysis of patients with BMI ≥ 25kg/m2. RLR demonstrated superior outcomes vs OLR: shorter median operative time (median 105.0 vs. 192.5min, p < 0.001), reduced blood loss (50 vs 300mL; p < 0.001), lower transfusion rates (3.0% vs 20.0%; p < 0.05), abbreviated hospital stay (9 vs 16days; p < 0.001), and faster recovery (postoperative stay: 5 vs 8days; p < 0.001). Univariate analysis revealed that increased blood loss was significantly associated with surgical approach, platelet count, POD (postoperative days), operation time, and ALT level. Multivariate analysis confirmed that longer operation time was an independent predictor of increased intraoperative blood loss. High-BMI RLR patients had significantly reduced operative time (105.0 vs 231.0min; p = 0.001), blood loss (30.0 vs 400.0mL; p < 0.001). Robotic isolated caudate lobectomy for hemangioma is feasible and safe, offering significant perioperative advantages over open surgery-including reduced blood loss, shorter hospitalization, and accelerated recovery-even in high-BMI patients. Robotic resection represents a viable surgical option for selected patients with hepatic caudate lobe hemangiomas.

Laparoscopic liver resection is superior to open liver resection for hepatocellular carcinoma patients with BCLC stage 0-A hepatocellular carcinoma and portal hypertension.

BackgroundThe feasibility and safety of laparoscopic liver resection (LLR) and open liver resection (OLR) in combined hepatocellular-cholangiocarcinoma (cHCC-CCA) patients remain controversial. This study compared the clinical outcomes of LLR versus OLR for patients with cHCC-CCA.MethodsClinicopathological features of cHCC-CCA patients who underwent liver resection (LR) between 2010 and 2022 were retrospectively analyzed. Propensity score matching (PSM) was employed to balance intergroup differences. Univariate and multivariate Cox analyses were employed to identify independent predictors of overall survival (OS).ResultsOf the 141 cHCC-CCA patients, 78 underwent LLR and 63 underwent OLR. After PSM, the LLR group had lower estimated blood loss (EBL) (200 vs. 300 mL, P=0.004) and shorter postoperative length of stay (LOS) (10.0 vs. 15.0 days, P<0.001). Multifactor Cox regression analyses showed that hepatocellular carcinoma (HCC) as the tumor main ingredient [hazard ratio (HR) =0.323, 95% confidence interval (CI): 0.151–0.693, P=0.004] was an independent protective factor for OS. After PSM, no statistically significant difference in OS was observed between the two groups (60.0 vs. 69.0 months, P=0.54).ConclusionscHCC-CCA patients undergoing LLR are safe and feasible with lower EBL, and shorter postoperative LOS. No statistically significant difference in long-term OS was observed between LLR and OLR.

There is still poor evidence about the safety and feasibility of minimally invasive liver surgery (MILS) for huge (> 10cm) 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. 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. 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. 10days, p < 0.01), as well as the median intraoperative estimated blood loss (500ml vs 800ml, 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 52months, there were no significant differences between OLR and MILS in median OS (44 vs. 93.6months, respectively; p = 0.07). Median DFS was improved after MILS (49.8 vs. 7months, respectively; p < 0.01). 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.

Robotic liver resection (RLR) has emerged as a minimally invasive alternative to open liver resection (OLR) for selected primary liver tumors, but its application for major hepatectomies remains limited. This retrospective study included patients who underwent hepatectomy for hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (iCC) at Ulm University Hospital (Nov 2020-Sep 2023) and Klinikum Nuremberg (Dec 2023-Jun 2025). Patients underwent RLR (n = 65) or OLR (n = 35). Demographics, operative data (including IWATE score), and postoperative outcomes-length of stay (LOS), blood loss, complications (Clavien-Dindo), and 90-day mortality-were compared using Fisher's exact and Mann-Whitney U tests (p < 0.05). A total of 100 patients were analyzed. Median age was 68.0years (IQR 63.0-74.0) in RLR vs. 70.05years (IQR 63.5-78.3) in OLR. LOS was significantly shorter after RLR (5days [IQR 4-7] vs. 11days [IQR 7-20.5], p < 0.001). Operative time tended to be lower with RLR (173min [IQR 135-237] vs. 219min [IQR 177-287], p = 0.072), and blood loss was significantly reduced (300ml [IQR 100-625] vs. 750ml [IQR 400-1450], p = 0.001). Bile leakage occurred in 4.6% (RLR) vs. 17.1% (OLR) (p = 0.062); re-interventions in 7.7% vs. 14.2% (p = 0.313). Severe complications (Clavien-Dindo ≥ IIIa) were less frequent after RLR (30.8% vs. 48.6%, p = 0.087). Post-hepatectomy liver failure occurred in 15.4% vs. 28.6% (p = 0.126); post-hepatectomy hemorrhage in 0% vs. 5.7% (p = 0.120). Ninety-day mortality was 4.6% (RLR) vs. 5.7% (OLR) (p = 1.0). IWATE scores were lower in RLR (6.0 [IQR 5.0-9.0]) vs. OLR (8.5 [IQR 7.0-10.0], p = 0.004). R0 resection was achieved in 76.6% in RLR vs. 82.9% in OLR (p = 0.28). In selected HCC or iCC patients, RLR was associated with shorter hospitalization, reduced blood loss, and with comparable complication rates in the full cohort and subgroup analysis. Overall OLR was applied to more complex resections and favored in vascular resection and biliodigestive anastomoses. These findings support RLR integration and highlight the need for prospective studies in complex cases.

Letter to the Editor on: "Feasibility of robotic liver resection compared with laparoscopic and open liver resection for hepatocellular carcinoma: a network meta-analysis".

A commentary on "Feasibility of robotic liver resection compared with laparoscopic and open liver resection for hepatocellular carcinoma: a network meta-analysis".

Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection (MISRLR). However, limited technical guidance is available. To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR. We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024. Beginning in October 2019, a liver surface-guided encirclement of hepatoduodenal ligament (LSEH) was used for repeat Pringle taping. Perioperative outcomes including Pringle taping success, operative time, blood loss, conversion rate, morbidity, and mortality were assessed. Laparoscopic and robotic approaches were used in 63 patients and 9 patients, respectively. The median operative time, blood loss, and hospital stay were 331.5 minutes, 70 mL, and 8 days, respectively. Open conversion occurred in two cases (2.8%) due to severe adhesions and right renal vein injury. Clavien-Dindo grade ≥ III complications occurred in 5.6% of cases with no mortality. Anti-adhesion barriers were used in 54 patients (75.0%). LSEH was attempted in 57 cases, improving Pringle taping success from 33.0% to 91.4% (P < 0.001). LSEH succeeded in all patients with prior open liver resection (n = 11). Among 6 patients in whom LSEH failed, 3 patients (50.0%) had undergone a third liver resection, and 1 patient had a history of distal gastrectomy with choledochoduodenostomy. The newly developed LSEH technique for Pringle taping in MISRLR was feasible, enhancing safety and reproducibility even in patients with a history of open liver resection.

Abstract Background Minimally invasive techniques for minor liver resections have advanced significantly, with robotic and laparoscopic approaches increasingly replacing traditional open surgery. While these methods are thought to improve patient outcomes and reduce healthcare costs, direct comparative data remain limited. Method A prospective dataset of 141 patients undergoing robotic (n = 47), laparoscopic (n = 47), and open (n = 47) minor liver resections at Southampton General Hospital (2022–2024) was analysed. Outcome measures included total hospital stay, HDU stay, intraoperative blood loss, transfusion requirement, readmission, grade ≥3 complications, and conversions to open surgery. Statistical analysis was performed using SPSS (Kruskal-Wallis and Chi-square tests). Cost effectiveness was evaluated based on per-procedure savings. Results Median total length of stay was significantly lower in the robotic and laparoscopic groups (3 days) compared to open surgery (5 days, p = .001). Robotic and laparoscopic procedures were associated with significantly lower intraoperative blood loss (100 mL) compared to open (525 mL, p &amp;lt; .001). Conversion to open surgery was significantly more common in the laparoscopic group (10 cases) than in the robotic group (2 cases, p = .013). Differences in transfusion rates (p = .091), readmission (p = .919), and major complications (p = .179) were not statistically significant. Estimated cost savings per procedure favoured robotic over open (£1374) and laparoscopic approaches (£488). Conclusions Robotic minor liver surgery demonstrated improved clinical outcomes and greater cost effectiveness compared to open and laparoscopic approaches. These findings support the continued integration of robotic surgery in hepatobiliary practice.

Laparoscopic liver resection (LLR) is widely accepted; however, no prospective study has identified risk factors for conversion to open surgery. This multicenter prospective study aimed to identify risk factors for conversion to hand-assisted laparoscopic surgery or open liver resection and evaluate the impact of conversion on perioperative outcomes in LLR. From June 2020 to May 2024, patients scheduled for wedge resection or left lateral segmentectomy for solitary liver tumor < 5cm were enrolled across seven institutions. A laparoscopic approach was employed for all patients. The primary endpoint was the identification of risk factors for conversion. As secondary endpoints, we compared perioperative outcomes between LLR and conversion. Among 199 patients, 172 (86.4%) completed LLR, while 27 (13.6%) required conversion. Multivariate analysis identified third or subsequent liver resection (P < 0.001) and male sex (P = 0.029) as significant risk factors for conversion. Conversion was significantly associated with longer operative time (P = 0.001), greater blood loss (P < 0.001), decreased implementation of the Pringle maneuver (P = 0.013), and prolonged hospital stay (P = 0.001). These findings highlight that conversion negatively impacts short-term outcomes. Awareness of these risk factors may support better surgical planning and risk stratification for patients undergoing LLR.

Aim . To validate the national model of the textbook outcome and modified textbook outcome when comparing shortterm outcomes of laparoscopic and open liver resections for colorectal liver metastases. Material and Methods . A retrospective analysis was conducted on patients operated on between June 2017 and January 2020 in two specialized centers in Russia. Indicators of achieving the textbook outcome and modified textbook outcome, along with factors influencing their attainment were considered. The 75th percentile of the length of hospital stay was used as the modifier for the modified textbook outcome. Results . Out of 171 cases who underwent surgery, 96 patients were treated in Center No. 1 and 75 in Center No. 2. A total of 85 open liver resections and 86 laparoscopic liver resections were performed. In Center No. 1, open and laparoscopic resections were performed in 47 (49%) and 49 (51%) patients, respectively; in Center No. 2, in 43 (57%) and 32 (43%) patients, respectively. The textbook outcome was achieved in 118 patients (69%), with 73 (76%) in Center No. 1 and 45 (60%) in Center No. 2 (p = 0.024). Conclusions . The textbook outcome and modified textbook outcome models are suitable for clinical practice and can be used to compare liver resection results. Incorporating the 75th percentile of hospital stay into the modified textbook outcome reduces bias from non-clinical factors when evaluating treatment duration.

This study aimed to compare both perioperative and oncological outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) for patients with large (5-10cm) or huge (> 10cm) hepatocellular carcinoma (HCC). This study analyzed consecutive patients with large or huge HCC who underwent either LLR or OLR across eight medical centers between January 2015 and December 2021. Clinical data were collected from prospectively maintained databases. To address potential selection bias inherent in retrospective studies, we performed 1:1 propensity score matching (PSM) analysis. We enrolled 560 patients undergoing OLR and 421 patients undergoing LLR based on predefined inclusion criteria. After PSM (369 patients per group), the LLR group demonstrated superior perioperative outcomes compared to the OLR group, including significantly reduced operative duration, decreased intraoperative blood loss, and shorter hospitalization. Long-term oncological outcomes were comparable between approaches, with no significant differences in overall survival (OS) or recurrence-free survival (RFS). Multivariate Cox regression identified several independent prognostic factors for both OS and RFS: serum alpha-fetoprotein > 400ng/mL, tumor size (both 5-10cm and > 10cm), multifocal disease, and microvascular invasion. Subgroup analyses confirmed the advantages of LLR across tumor size categories. For large HCC, LLR patients exhibited significantly less blood loss and shorter hospital stays. Similarly, in huge HCC, the LLR group showed reduced blood loss and faster recovery compared to the OLR group. LLR is a safe and effective alternative to OLR for selected patients with large or huge HCC, offering superior perioperative outcomes while maintaining equivalent long-term survival.

Hepatectomy remains the standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage 0/A hepatocellular carcinoma (HCC). However, debates persist regarding the optimal surgical approach-robot-assisted (RALR), laparoscopic (LLR), or open liver resection (OLR)-due to differences in perioperative outcomes, recurrence patterns, and cost-effectiveness. While minimally invasive techniques offer potential advantages, such as reduced morbidity and faster recovery, their comprehensive impact remains unclear. This study evaluates and compares the intraoperative, postoperative, and economic outcomes of these three approaches in a multicenter cohort of BCLC 0/A HCC patients. Propensity score matching (PSM) was performed to balance baseline characteristics across RALR, LLR, and OLR groups (714 patients each). Intraoperative and postoperative outcomes, as well as long-term recurrence-free survival (RFS) and overall survival (OS), were assessed. Cost-effectiveness was evaluated using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). This nationwide retrospective study analyzed 2882 BCLC 0/A HCC patients from 27 centers. After propensity score matching, 2142 patients were analyzed (714 in each group). Operative time was longer in RALR (225min) and LLR (225min) compared to OLR (170min, P < 0.001). Postoperative complication rates were lower in RALR (12.5%) and LLR (13.4%) than in OLR (17.1%, P < 0.001), with fewer severe complications (Clavien-Dindo grade ≥ IIIa). The OLR group had a higher proportion of advanced-stage recurrences (BCLC B/C/D: 70.3%) versus RALR (37.9%) and LLR (35.9%) (P < 0.001). RALR achieved the highest 5-year QALYs (1.143) among the three groups, while LLR demonstrated superior cost-effectiveness with an ICER of -$24,379/QALY compared to OLR. For BCLC 0/A HCC patients, RALR and LLR demonstrated lower incidence and severity of complications, less advanced-stage recurrence, and higher cost-effectiveness compared to OLR. These findings support the broader adoption of minimally invasive techniques to improve long-term outcomes and quality of life. Despite RALR's higher initial costs, it remains a highly cost-effective option, offering superior quality of life and long-term economic benefits.

Minimally invasive liver surgery (MILS) has become increasingly established, yet the relative benefits of laparoscopic (LLR) and robotic-assisted liver resection (RLR) compared with open liver resection (OLR) across different levels of surgical difficulty remain debated. This study aimed to compare perioperative outcomes of RLR, LLR, and OLR stratified by the IWATE difficulty score. All consecutive patients undergoing elective liver resection between April 2018 and December 2024 at a high-volume hepatobiliary center were retrospectively analyzed from a prospectively maintained database. Patients were stratified into low/intermediate (IWATE 0-6) and advanced/expert (IWATE 7-12) groups. Multivariable regression and interaction term analyses were performed to adjust for confounders and assess the modifying effect of surgical difficulty. A total of 686 patients were included: 425 (62%) underwent LLR, 101 (15%) RLR, and 160 (23%) OLR. Of these, 400 (58%) were advanced/expert resections. Minimally invasive approaches were associated with significantly reduced blood loss, morbidity, and length of stay compared with OLR across all IWATE levels. In advanced/expert resections, RLR provided the greatest benefit, with lower major complications (8% vs. 17% LLR vs. 23% OLR) and shorter length of stay (median 6 vs. 9 days OLR). Multivariable analyses confirmed these findings, with both LLR (OR 0.24, 95% CI 0.10-0.55) and RLR (OR 0.24, 95% CI 0.06-1.00) independently associated with reduced major complications compared to OLR. Interaction analyses demonstrated that the comparative advantage of RLR was most pronounced in advanced/expert resections, while LLR showed particular efficiency in low/intermediate cases. Both LLR and RLR are safe and effective across all levels of surgical difficulty. RLR, however, offers distinct advantages in technically demanding advanced and expert cases. These findings reinforce the role of MILS as the preferred standard and highlight the importance of tailoring the surgical approach to case complexity.

In recent years, more complex robotic-assisted liver resections (RLR) have been performed, providing a viable alternative to open liver resection (OLR). While the short-term benefits of minimally invasive surgery are well known, including reduced blood loss and shorter hospital stay, the inflammatory response to different surgical approaches remains poorly understood. This study examines the immune response in peripheral blood and local liver and peritoneal tissue during and after liver surgery in 22 patients (11 in each group). The study analyzes clinical and laboratory parameters, leukocyte activation, and cytokine/chemokine levels before and after liver parenchyma dissection using L-selectin shedding assay and FACS multiplex analysis panel. In the perioperative course, systemic and local liver cytokine levels of IL-6 and IL-10 are reduced in RLR. The laparotomy itself resulted in higher baseline levels of IL-6, IL-8, CXCL10, IFNγ, TGFβ1, and IL-1β in local liver tissue of the OLR group. After liver parenchyma dissection, RLR patients exhibited reduced levels of IL-6, IL-8, IFNγ, MCP1, IL-1β, TGFβ1, and CXCL10 in the liver compared to the OLR group. In the late postoperative course from postoperative day (POD) 5-20, systemic chemokine MCP1 was reduced, alongside a decrease of CD4+/CD8+ lymphocytes and higher L-selectin shedding capacity in the RLR group from POD5 onwards. These findings suggest that RLR preserves immune competence more effectively than OLR in the peri- and late postoperative course. The reduced systemic and local inflammatory response may be the result of less tissue damage with reduced cytokine release, highlighting the value of less traumatic surgery applied by robotic systems during clinical practice.

BACKGROUNDColorectal cancer is the third most common malignancy globally, with the liver being the predominant site of metastatic disease.AIMTo evaluate safety, feasibility, and outcomes of robotic liver resection (RLR) versus laparoscopic liver resection (LLR) and open liver resection (OLR) for colorectal metastasis (CRLM).METHODSThis study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Systematic searches in PubMed, EMBASE, Scopus, and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM. Two independent reviewers screened studies using predefined PICO (Population, Intervention, Comparator, Outcome) criteria, with data extraction focusing on conversion rates, operative outcomes, morbidity, mortality, and survival. Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2. Pooled analyses were performed for comparative data; noncomparative studies were narratively synthesized.RESULTSPooled evidence from two comparative systematic reviews (9792 patients) demonstrated that RLR offers distinct advantages over LLR and OLR, including significantly lower conversion rates (4.7%–6.7% vs 10.4%–12.4%, P < 0.001) and reduced intraoperative blood loss (190.8–266.8 mL vs 283.9–294.3 mL, P < 0.001) despite longer operating times (mean 304.1 vs 191.8 min). Perioperative safety and oncologic outcomes (R0 resection > 82%; 5-year overall survival: 53.1%–60.8%) were comparable across approaches. Three additional noncomparative reviews (n = 274) highlighted the technical practicability of RLR in complex cases (zero conversions in small cohorts, median 399.5 min for simultaneous resections). However, these findings were not included in pooled analyses due to the lack of comparator groups. Noncomparative data (n = 274) revealed higher upfront costs for RLR due to prolonged operating times (median 399.5 min) and the need for expensive equipment; however, no formal cost comparisons were available.CONCLUSIONRLR is a safe and feasible alternative to LLR and OLR for CRLM, demonstrating superior technical performance and comparable short-term outcomes.

This study aimed to compare perioperative and long-term outcomes between laparoscopic (LLR) and open liver resection (OLR) in elderly patients with solitary hepatocellular carcinoma (HCC). The study consecutively included patients aged ≥ 70years who underwent curative liver resection for single HCC at four tertiary centers between January 2015 and December 2021. Perioperative short-term and long-term survival outcomes were compared between the LLR and OLR groups. Propensity score matching (PSM) was performed in a 1:1 ratio to balance baseline characteristics between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors associated with overall survival (OS) and recurrence-free survival (RFS). Of the 180 patients, 94 and 86 were included in the LLR and OLR groups, respectively. After PSM, 65 patients were included in each group. Intraoperative blood loss (p = 0.010), operative time (p = 0.021), length of hospital stay (p = 0.021) and 90-day readmission rate (p = 0.048) were significantly lower in the matched LLR than the matched OLR group. Moreover, postoperative ascites complication was less frequent in the matched LLR group (p = 0.046). Long-term survival outcomes were better in the LLR group compared with the OLR group both before and after PSM (for OS: p = 0.019 and 0.003; for RFS: p = 0.023 and 0.012). Multivariate Cox regression analysis found that open hepatectomy was an independent risk factor of OS and RFS for elderly HCC patients compared to laparoscopic approach. For selected elderly patients with solitary HCC, particularly those with tumors in locations amenable to a minimally invasive approach, LLR was associated with superior perioperative and long-term survival outcomes compared to OLR. Not applicable because this is a retrospective observational study.

Many studies demonstrated the feasibility of laparoscopic liver resection (LLR). However, its short-term outcomes for liver malignancies located in involving Couinaud's segment 7 have not been appraised compared to open liver resection (OLR). In addition, the impact of the LLR learning curve on surgical outcomes at these sites remains unclear. This single-institution, retrospective study included 216 patients who underwent liver resection for malignancies involving segment 7 between 2010 and 2024. Propensity score matching balanced LLR (n = 65) and OLR (n = 65) cohorts. Surgical outcomes were compared and the LLR learning curve for conversions was plotted via risk-adjusted cumulative sum (RA-CUSUM) analysis. LLR showed shorter postoperative hospital stays and a trend towards less blood loss. Despite longer operative times, LLR had lower postoperative white blood cell counts and similar alanine aminotransferase levels. There were no significant differences between the groups in the overall or severe complications. Moreover, RA-CUSUM analysis showed that after the surgeon completed around 30 patients, the conversion rate stabilized and improved, leading to enhanced safety. LLR could act as a safe alternative to OLR in patients harboring malignancies involving segment 7, with accumulated experience contributing to improved outcomes.

BackgroundLaparoscopic liver resection has been associated with less morbidity than, and similar global outcomes to, open liver resection. There is no robust evidence that these outcomes lead to similar clinical outcomes in patients aged over 80 years. The aim of this study was to analyse the short-term outcomes between open and laparoscopic liver resection in patients over 80 years old.MethodsA retrospective analysis was undertaken. The study population comprised patients aged ≥ 80 years who underwent laparoscopic or open liver resection between January 2014 and December 2019, and who presented with resectable malignant tumours. The primary outcome was postoperative morbidity, according to Dindo-Clavien grading. Cox regression models were used to compute hazard ratios and 95% confidence intervals. Propensity score matching (1 : 1) was performed to balance the two groups according to independent prognostic factors for morbidity.ResultsA total of 988 patients were analysed from 34 centres (16 from Asia, 14 from Europe and 4 from America): 487 in the open group and 501 in the laparoscopic group. Independent risk factors associated with severe morbidity were the open approach (hazard ratio 1.59, 95% confidence interval 1.19 to 2.11; P < 0.001), Charlson Co-morbidity Index score > 7 (HR 1.69, 1.26 to 2.27; P < 0.001), more than one resected tumour (hazard ratio 1.55, 1.13 to 2.11; P = 0.006), major hepatectomy (hazard ratio 1.86, 1.22 to 2.83; P = 0.003), and Iwate score ≥ 7 (hazard ratio 1.43, 1.02 to 2.01; P = 0.03). Before propensity score matching, severe morbidity, length of intensive care unit stay, 90-day mortality, length of hospital stay, and readmission were better in the laparoscopic group (P < 0.050). These observations were confirmed after propensity score matching.ConclusionThe laparoscopic approach is a safe procedure for elderly patients, with better morbidity and mortality outcomes than the open approach, and should be considered as a default option.