To evaluate the safety and efficacy of laparoscopic right hemihepatectomy (LRH) in the treatment of hepatocellular carcinoma (HCC).

Clinical data of 85 HCC patients admitted to the First People's Hospital of Foshan from January 2014 to July 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 75 patients were male and 10 female, aged 29-74 years with a median age of52 years. All patients were classified as Child-Pugh A, and the tumor diameter was <8 cm. According to different surgical procedures, all patients were divided into the LRH group and open right hemihepatectomy (ORH) group. Standardized and processed right hemihepatectomy via the anterior approach was adopted in two groups. The operation time and the length of postoperative hospital stay between two groups were compared by t test or rank-sum test. The rate comparison, such as the incidence rate of postoperative complications, between two groups was compared by Chi-square test or Fisher's exact probability test. Survival analysis was conducted by Kaplan-Meier curve and Log-rank test.

The average operation time in the LRH group was (332±52) min, significantly longer than (287±59) min in the ORH group (t=3.316, P<0.05). The time to first flatus in the LRH group was (1.5±0.9) d, significantly shorter than (2.8±0.8) d in the ORH group (t=-3.119, P<0.05). The median length of postoperative hospital stay in the LRH group was 9(2) d, significantly shorter than 12(4) d in the ORH group (Z=-3.210, P<0.05). No perioperative death was reported in the LRH group, 2 cases in the ORH group, and no significant difference was observed between two groups (P=0.508). In the LRH group, the incidence of postoperative complications was 16%(4/25) and 33%(20/60) in the ORH group, and no significant difference was observed between two groups (χ²=2.617, P>0.05). In the LRH group, no hepatic marginal recurrence occurred, and 1 case had abdominal implantation metastasis. In the ORH group, 1 case developed hepatic marginal recurrence and 2 cases of abdominal implantation metastasis. No significant differences were observed in hepatic marginal recurrence (P=1.000) and abdominal implantation metastasis (χ²=0.243, P>0.05) between two groups. In the LRH group, the postoperative 1-, 3-year tumor-free survival rates were 72.0%, 62.6%, and 65.6%, 41.0% in the ORH group, respectively. No significant difference was observed between two groups (χ²=2.835, P>0.05). In the LRH group, the postoperative 1-, 3-year overall survival rates were 96.0%, 75.4%, and 88.3%, 76.5% in the ORH group, respectively. No significant difference was observed between two groups (χ²=0.016, P>0.05).

It is safe and feasible to apply standardized and processed LRH via the anterior approach for the treatment of HCC, which has multiple advantages of minimal invasiveness and rapid postoperative recovery. Moreover, LRH yields equivalent tumor-free survival and overall survival to ORH.