ORIGINAL SCIENTIFIC REPORT Laparoscopic Versus Open Right Posterior Sectionectomy for Hepatocellular Carcinoma in a High-Volume Center: A Propensity Score Matched Analysis Jinsoo Rhu 1 • Sung Joo Kim 1 • Gyu Seong Choi 1 • Jong Man Kim 1 • Jae-Won Joh 1 • Choon Hyuck David Kwon 1 Ó Socie ´te ´ Internationale de Chirurgie 2018 Abstract Background While minimal invasive surgery is becoming popular in liver resection, right posterior sectionectomy (RPS) is still considered as a difficult procedure. We summarize the clinical data and investigate the feasibility of laparoscopic right posterior sectionectomy (LRPS) in hepatocellular carcinoma (HCC) by comparing its outcomes with those of open right posterior sectionectomy (ORPS). Methods We retrospectively reviewed 191 patients who underwent RPS for HCC during January 2009 to August 2016 at Samsung Medical Center. After 1:2 propensity score matching, 53 patients in LRPS group were matched to 97 patients in ORPS group. Results There was no statistical difference in preoperative data. While operation time was significantly longer in LRPS group (381.1 ± 118.7 vs. 234.4 ± 63.7 min, P \ 0.001), transfusion rate (13.2 vs. 2.1%, P = 0.061) and complication rate (9.4 vs. 8.3%, P = 0.709) were not statistically different between groups. Clustered Cox pro- portional hazards regression analysis for matched paired data showed no difference in both disease-free survival (P = 0.607) and overall survival (P = 0.858). Conclusions In HCC, LRPS can be performed safely compared to ORPS, regarding the operative outcome, patient recovery, and oncological outcomes. Introduction Liver resection has become an established procedure for hepatocellular carcinoma (HCC) in cirrhotic patients [1, 2]. Furthermore, laparoscopic liver resection is becoming increasingly popular, and when patients are selected properly, it is considered safe with low mortality and morbidity [3]. Not only for normal liver function, but also for cirrhotic patients who have HCC, laparoscopic liver resection is becoming safe with an improvement in post- operative course [4, 5]. However, most of the reported cases were minor resections, such as tumor resection and left lateral sec- tionectomy [6–8]. The 2008 Louisville Statement and its revision in Morioka in 2014 propose that major liver resection should be performed by experienced surgeons [9, 10]. And the Statement defined major liver resection as hemihepatectomies, trisectionectomies, and resection of the difficult posterior segments, that is, segments 4a, 6, and 7[9, 10]. Recently, there have been numbers of literatures expressing the feasibility of laparoscopic major resections [11, 12]. Laparoscopic right posterior sectionectomy (LRPS) has first been performed more than a decade ago [13]. However, due to its technical difficulty, it is classified as one of the most challenging procedures and thus not & Choon Hyuck David Kwon chdkwon@skku.edu 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon- dong, Gangnam-gu, Seoul 135-710, Korea 123 World J Surg https://doi.org/10.1007/s00268-018-4531-z