Background : During hepatectomy for hepatocellular carcinoma (HCC), technical challenges vary based on the tumor location. Hepatectomy in posterosuperior (PS) segment is known to be more challenging than the anterolateral (AL) segment. The aim of this study is to investigate how technical difficulties due to tumor location influence postoperative outcomes, and to identify the factors affecting these results.

Methods : A retrospective study included 505 patients who underwent curative liver resection for HCC from Janurary 2010 to December 2020. Patients were classified into AL group(n=315) and PS group(n=190 based on tumor location. The clinical data of the two groups were retrospectively analyzed, and propensity score matching and subgroup analysis were done.

Results : PS group had a significantly higher rate of open surgery (p=0.001) compared to AL group. Both major complications (CDC ≥3) and 90-day mortality rates were significantly higher in the PS group (p=0.021). After propensity score matching, the PS group showed longer operation times (p<0.001), increased estimated blood loss (EBL) levels (p=0.003), more frequent Pringle maneuver (p=0.013), and a greater incidence of open conversion (p=0.046). Despite these differences, major complications and 90-day mortality rates were similar between two groups. In a subgroup analysis of patients with a BMI≥25 (p=0.043) and underwent anatomical resection(p=0.017), the AL group showed better overall survival than the PS group.

Conclusions : Hepatectomy in PS segments compared to AL segments presents technical challenges, including longer operation times, increased EBL, and higher open conversion rates. However, there was no difference in overall survival (OS) and disease-free survival (DFS) between the groups. In specific subgroups, patients with BMI≥25 and those undergoing anatomical resection, the AL group shows a significantly better overall survival compared to PS group, suggesting that operation technical difficulties may influence survival outcome.