Laparoscopic versus open liver resection in hepatocellular carcinoma patients with sarcopenia: a retrospective cohort study

Background Sarcopenia identifies patients with hepatocellular carcinoma (HCC) who have reduced physiological reserve and an increased risk of adverse outcomes after hepatectomy. However, whether laparoscopic liver resection (LLR) is associated with better perioperative and long-term outcomes than open liver resection (OLR) in this vulnerable population remains uncertain. Methods We retrospectively evaluated consecutive adults with pathologically confirmed HCC and preoperative computed tomography-defined sarcopenia who underwent curative-intent liver resection at a high-volume center in China between January 2017 and December 2021. The primary outcomes were recurrence-free survival (RFS) and overall survival (OS). One-to-one propensity score matching was used as the primary adjustment method, with overlap weighting and stabilized inverse probability of treatment weighting as sensitivity analyses. Results Among 285 patients, 110 underwent LLR and 175 underwent OLR. Compared with OLR, LLR was associated with lower estimated blood loss (median, 150 vs. 200 mL), a shorter postoperative hospital stay (12 vs. 13 days), and fewer Clavien–Dindo grade ≥II complications (20.9% vs. 34.3%), whereas major complications, anatomical resection rates, and wide resection margins were comparable. After propensity score matching, 96 patients were retained in each group. During a median follow-up of approximately 55 months, LLR was associated with longer RFS (HR 0.56, 95% CI 0.37–0.84) and OS (HR 0.54, 95% CI 0.34–0.87). Similar associations were observed in the overlap-weighted and stabilized inverse probability-weighted analyses. Conclusion Among selected HCC patients with computed tomography-defined sarcopenia, LLR was associated with a lower perioperative burden and favorable long-term outcomes without an apparent compromise in major morbidity or technical oncologic quality. Prospective multicenter studies are required to confirm these findings and determine whether reduced surgical stress contributes to preservation of muscle health and functional recovery.