Abstract: Objective:To investigate the clinical efficacy of laparoscopic anatomical resection of the right posterior section combined with the dorsal segment of the right anterior section versus standard right hepatectomy for hepatocellular carcinoma (HCC).
Methods:A retrospective descriptive study was conducted. The clinical data of 34 patients with HCC admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from January 2020 to January 2025 were collected. Based on the surgical procedures, the patients were divided into the combined resection group (anatomical resection of the right posterior section combined with the dorsal segment of the right anterior section, n=17) and the standard right hepatectomy group (right hepatectomy group, n=17). Intraoperative conditions, postoperative recovery indicators, and long-term follow-up prognosis were compared and analyzed between the two groups.
Results:Intraoperative findings demonstrated that all 34 patients successfully underwent laparoscopic anatomical hepatectomy without conversion to open surgery. Compared with the right hemihepatectomy group, the combined resection group exhibited longer operative duration and prolonged hepatic hilum occlusion time; however, both groups showed comparable intraoperative blood loss and transfusion volumes. The residual liver volume predicted by three-dimensional reconstruction was significantly larger in the combined resection group than in the right hemihepatectomy group. Postoperative evaluations revealed no in-hospital deaths or readmissions within 30 days among all 34 patients. Histopathological examinations confirmed hepatocellular carcinoma in all cases, with negative surgical margins. The combined resection group exhibited lower incidence of postoperative complications such as bile fistula and ascites, which resolved after irrigation drainage and peritoneal puncture drainage. The risk of postoperative liver failure was slightly lower in the combined resection group compared to the right hemihepatectomy group, though the difference was not statistically significant (P=0.403). Follow-up until March 1, 2026, showed that the combined resection group achieved superior overall survival and recurrence-free survival rates compared to the right hemihepatectomy group, although these differences were not statistically significant (P=0.34 and P=0.60).
Conclusions:Laparoscopic anatomical resection of the right posterior section combined with the dorsal segment of the right anterior section is safe and feasible for the treatment of HCC. Compared with standard right hepatectomy, this procedure can significantly preserve more future liver remnant and reduce the risk of postoperative liver failure, offering better perioperative benefits without compromising long-term oncological outcomes.

Key words: Hepatocellular carcinoma, Near-infrared fluorescence laparoscopy, Anatomical hepatectomy, Portal vein basin, Indocyanine green, Intraoperative ultrasound, Surgical resection