Objective: To compare the safety and efficacy of laparoscopic and open liver resection for BCLC-A hepatocellular carcinoma (HCC) between well-matched patient groups.  
Methods: The clinical data of 313 patients with BCLC-A HCC undergoing primary hepatectomy from January 2012 to December 2016 in the Department of Hepatobiliary Surgery of Hunan Provincial People's Hospital were retrospectively analyzed. Among them, 102 cases underwent laparoscopic hepatectomy (laparoscopic group) and 211 cases underwent open hepatectomy (laparotomy group). The 1:1 propensity score matching (PSM) was performed using the baseline variables that included tumor characteristics, general conditions and resection types of the patients. Then, the relevant clinical variables were compared between the two groups.
Results: The baseline variables were well balanced between the two groups after PSM (the area under ROC curve was 0.584), with 86 matched patients in each group. In laparoscopic group compared with laparotomy group, no significant differences were noted regarding the histological grade, microvascular invasion and positive margin (all P>0.05), but the intraoperative blood loss (100 mL vs. 200 mL), proportion of cases requiring intraoperative blood transfusion (4.7% vs.16.3%), operative time (160 min vs. 200 min), postoperative hospital stay (9 d vs. 12 d) and incidence of complications (5.8% vs. 16.3%) were significantly reduced (all P<0.05); the overall survival rate and tumor-free survival rate had no significant differences between them (P=0.863, P=0.789).
Conclusion: For BCLC-A HCC, laparoscopic hepatectomy has efficacy similar to that of open hepatectomy, but the former has better perioperative safety.