ObjectiveTo compare the long-term outcomes of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in the treatment of hepatocellular carcinoma (HCC), and to discuss the recurrence patterns of HCC after surgery. MethodsPatients with HCC who underwent hepatectomy and met inclusion and exclusion criteria from January 2015 to December 2018 were retrospectively enrolled, then were divided into LH and OH groups according to surgical methods. The results of HCC recurrence after LH and OH were compared after 1∶1 propensity score matching between the two groups. The potential risk factors for recurrence were assessed by Cox proportional hazards regression and a nomogram was constructed. ResultsA total of 977 patients with HCC who underwent hepatectomy were enrolled. Of these, 385 underwent LH and 592 underwent OH. After 1∶1 propensity score matching, 323 patients were enrolled in each group for analysis. The tumor recurrences were found in 124 patients (38.4%) and 118 patients (36.5%) and the median tumor free survival time was 10 months and 9 months in the LH group and OH group, respectively. The most common recurrence pattern was the intrahepatic recurrence, and the most common treatment was the transarterial chemoembolization. There was no significant difference of the relapse free survival curve between the LH and OH groups (P=0.763). In the entire cohort, no patient had recurrence or metastasis of specimen removal incisions or Trocar pores. No significant differences in the recurrence pattern and treatment between the LH and OH groups (P>0.05). Cox proportional hazards regression analysis showed that the age ≤60 years old, grade 2 of albumin-bilirubin grade, postoperative alpha fetoprotein >8 μg/L, tumor diameter ≥5 cm, multiple tumors, and low differentiation increased the recurrence of HCC after LH (P<0.05). The nomogram including these factors and combining with clinical practice was constructed, its consistent index for predicting the recurrence of HCC after LH was 0.704 [95%CI (0.659, 0.753)]. ConclusionIntrahepatic recurrence is still the most common pattern of postoperative HCC recurrence, and LH doesn’t increase risk of incision recurrence or implantation.