Background <p>Microvascular invasion (MVI) is one of the major risk factors for postoperative recurrence of HCC. For HCC patients with MVI, few studies have examined the differences in prognosis between minimally invasive and open liver resection.</p> Materials and methods <p>A total of 171 HCC patients with MVI who underwent curative-intent hepatectomy from September 2017 to October 2022 at Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, were enrolled in this study. Patients were categorized into minimally invasive liver resection (MILR) group (Robotic or laparoscopic) and open liver resection (OLR) group. In order to balance the baseline characteristics between the two groups, 1:4 propensity score matching (PSM) was performed on the two groups. The survival parameters and perioperative parameters were compared between the two groups before and after PSM, respectively.</p> Results <p>There was no significant difference in Recurrence Free Survival (RFS) and Overall Survival (OS) between the two groups before and after PSM. Subgroup analysis showed that there were no significant differences in OS and RFS between the two groups regarding anatomical resection, IWATE difficulty score, surgical margins, and postoperative adjuvant therapy. Perioperative parameters and the rate of major postoperative complications were comparable between the two groups.</p> Conclusion <p>Minimally invasive approach can provide a comparable long-term survival result compared with conventional open approach for patients with HCC associated with MVI.</p>