Laparoscopic hepatectomy achieves better outcomes for hepatocellular carcinoma patients with high-risk features, which matters for surgical selection and strategy.

• Textbook outcome rate after laparoscopic surgery was 75.8% compared to 67.7% for open surgery (p=0.041).
• Overall survival at 5 years was similar: laparoscopic 55.6% vs. open 55.5% (p=0.334).
• Recurrence-free survival also showed no significant difference: laparoscopic 39.6% vs. open 36.4% (p=0.116).

Laparoscopic approach is viable for high-risk patients, offering better feasibility without compromising survival outcomes.