Laparoscopic right posterior sectionectomy versus laparoscopic right hemihepatectomy for hepatocellular carcinoma in posterior segments: Propensity Score Matching Analysis

Background and Aims: This study was designed to analyze the feasibility of laparoscopic right posterior sectionectomy compared to laparoscopic right hemihepatectomy in patients with hepatocellular carcinoma located in the posterior segments. Material and Methods: The study included patients who underwent either laparoscopic right posterior sectionectomy or laparoscopic right hemihepatectomy for hepatocellular carcinoma located in segment 6 or 7 from January 2009 to December 2016 at Samsung Medical Center. After 1:1 propensity score matching, patient baseline characteristics and operative and postoperative outcomes were compared between the two groups. Disease-free survival and overall survival were compared using Kaplan-Meier log-rank test. Results: Among 61 patients with laparoscopic right posterior sectionectomy and 37 patients with laparoscopic right hemihepatectomy, 30 patients from each group were analyzed after propensity score matching. After matching, baseline characteristics of the two groups were similar including tumor size (3.41.2cm in laparoscopic right posterior sectionectomy vs 3.7 +/- 2.1cm in laparoscopic right hemihepatectomy, P=0.483); differences were significant before matching (3.1 +/- 1.3cm in laparoscopic right posterior sectionectomy vs 4.3 +/- 2.7cm in laparoscopic right hemihepatectomy, P=0.035). No significant differences were observed in operative and postoperative data except for free margin size (1.04 +/- 0.71cm in laparoscopic right posterior sectionectomy vs 2.95 +/- 1.75cm in laparoscopic right hemihepatectomy, P<0.001). Disease-free survival (5-year survival: 38.0% in laparoscopic right posterior sectionectomy vs 47.0% in laparoscopic right hemihepatectomy, P=0.510) and overall survival (5-year survival: 92.7% in laparoscopic right posterior sectionectomy vs 89.6% in laparoscopic right hemihepatectomy, P=0.593) did not differ between the groups based on Kaplan-Meier log-rank test. Conclusion: For hepatocellular carcinoma in the posterior segments, laparoscopic right posterior sectionectomy was feasible compared to laparoscopic right hemihepatectomy when performed by experienced laparoscopic surgeons.