Background: Associating liver partition with portal vein ligation for staged liver resection (ALPPS) has been used in the treatment of patients with advanced or massive liver cancer without sufficient future liver remnant, but concerns remain regarding tumor outcomes and surgical safety. This study aims to evaluate the efficacy and safety of a new procedure, hepatic artery restriction operation combined with ALPPS (HARO-ALPPS), in the treatment of hepatocellular carcinoma (HCC) patients especially with severe fibrosis. Methods: This retrospective study analyzed 8 patients who underwent HARO-ALPPS for HCC and compared their outcomes with 64 patients who underwent conventional ALPPS. The primary outcomes assessed were liver regeneration ability (measured by relative and absolute kinetic growth rates), postoperative complications, and mortality. The secondary outcomes included overall survival and disease-free survival. Results: HARO-ALPPS significantly restricted the blood supply of the hepatic artery. One week after surgery, the blood flow of the right hepatic artery dropped to 62.1%. At the same time, HARO-ALPPS shows superior liver regeneration ability, which is particularly prominent in the background of liver fibrosis. No serious complications occurred after HARO-ALPPS. The overall survival rate of HARO-ALPPS was 75%, which was higher than that of ALPPS (64%, P=0.816). Conclusion: Compared to conventional ALPPS, HARO-ALPPS exhibits a better liver regeneration ability, and favorable long-term outcomes. Further prospective studies are needed to validate these findings and evaluate the long-term oncologic outcomes of this novel procedure.

Robotic hepatectomy is widely used to treat liver tumors. However, there are limited studies comparing robotic hepatectomy with conventional open hepatectomy for large (≥ 5 cm) hepatocellular carcinoma. This study aims to evaluate the perioperative and long-term outcomes of patients with large and huge hepatocellular carcinoma undergoing robotic or open hepatectomy. This retrospective study included patients with large hepatocellular carcinoma who underwent robotic hepatectomy or open hepatectomy by the same surgical team at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, from January 2021 to January 2024. Propensity score matching (PSM) was used to minimize potential bias. According to the predetermined inclusion criteria, this study included 96 open hepatectomy(OH) patients and 23 robotic hepatectomy (RH) patients. After PSM, two homogeneous groups (RH and OH, n = 23 each) were created. The RH group had less blood loss (median 100 ml vs. 300ml, P = 0.008) and a lower incidence of postoperative pulmonary complications (8.7% vs. 39.1%, P = 0.016) compared to the OH group. There were no statistically significant differences in overall survival (OS) and disease-free survival (DFS) between the two groups. For patients with large(≥ 5 cm) hepatocellular carcinoma, robotic hepatectomy provides a safe, feasible and less invasive approach for treatment.