LAUSR

INTRODUCTION The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared to minimally invasive right hemihepatectomy (MI-RH). METHODS This is an international multicenter retrospective analysis of 1114 patients undergoing MI-RH, MI-RAS and MI-RPS at 21 centers between 2006-2019. MIS included pure laparoscopic, robotic, hand-assisted or hybrid approach. A propensity matched and coarsened-exact matched analysis was performed. RESULTS 1100 cases met study criteria of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted and 47 laparoscopic-assisted (hybrid) surgery. There were 632 RH, 373 RPS and 95 RAS. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 VS 300ml, p=0.001) as well as intraoperative blood transfusion rate (19.6% VS 10.7%, p=0.004). However, the overall morbidity rate was lower including major morbidity (7.1% VS 14.3%, p=0.007) and reoperation rate (1.4% VS 4.6%, p=0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% VS 8.9%, p<0.001). These findings were consistent after both propensity and coarsened-exact matching. CONCLUSION Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for MI-RH in right sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.