Introduction : Surgical complications for surgeons still in the learning phase for major laparoscopic liver resection (LLR) were frequently observed. We aim to compare perioperative and long-term outcomes of laparoscopic and open surgery based on surgeon learning curve for LLR after propensity score-matched analysis (PMS).

Methods : A retrospective study of all patients with histologic diagnosis of hepatocellular carcinoma who underwent major hepatectomy between January 2013 and December 2018. A PMS analysis was used to compare the groups of patients who underwent LLR and open major liver resection (OLR) before and after the learning curve was maximized.

Results : Among 405 patients, 106 underwent LLR and 299 underwent OLR; 79 were women and 326 were men. The mean age was 57.7 years. The learning curve was maximized after 42 cases. Compared to OLR, LLR had more liver-related injury and Clavien-Dindo grade ≥ 3 complications during the learning phase. The LLR group had less blood loss, fewer transfusion requirements, and fewer liver-related injuries during the experienced phase. Hospital stay was significantly shorter during and after maximization of the learning curve in LLR. Operative time was comparable in the two phases. Overall, LLR was associated with less blood loss, fewer complications, and shorter hospital stay compared to open surgery. There was no significant difference in long-term survival outcomes between the two groups.

Conclusions : LLR had higher incidence of liver-related complications during the surgeon’s learning phase compared to the open. This association was significantly diminished with surgeon experience. Overall, blood loss, surgical complications, and hospital stay better for LLR.