Background : Despite numerous efforts to achieve minimally invasive surgery, such as single-port laparoscopic surgery, few studies have provided long-term follow-up information, and the number of patients with hepatocellular carcinoma in previous studies has been small. The purpose in this study is to compare the long-term oncological outcomes of hepatocellular carcinoma patients who underwent single-port laparoscopic hepatectomy with those of patients who underwent multi-port laparoscopic hepatectomy.

Methods : We retrospectively reviewed the medical records of 135 patients with hepatocellular carcinoma who underwent laparoscopic hepatectomy between January 2008 and December 2018. Of the 135 patients, 53 underwent multi-port laparoscopic hepatectomy, and 82 underwent single-port laparoscopic hepatectomy. A 30–40-mm skin incision was made in the right upper quadrant or periumbilical area depending on the location and size of the liver mass.

Results : Neither long-term overall survival (P-value = 0.849) nor recurrence-free survival (P-value = 0.057) differed significantly between the two groups, even though the recurrence rate was higher in the single-port laparoscopic hepatectomy group. Multivariable analysis showed that the single-port laparoscopic hepatectomy method and portal vein invasion were independent adverse prognostic factors for recurrence-free survival.

Conclusions : Considering the potential risk of recurrence of HCC associated with the SPLH method, a cautious approach is warranted. Nevertheless, with careful patient selection focusing on those with favorable tumor locations, SPLH could emerge as a feasible surgical option.