The outcome of repeat laparoscopic liver resection after initial open or laparoscopic liver resections

Abstract

Background: Recurrence after hepatectomy is common for colorectal metastases (CRLM) and hepatocellular carcinoma (HCC), therefore repeat hepatectomy may be indicated. Laparoscopic repeat hepatectomy (LRH) is naturally proposed after initial laparoscopic liver resection (LLR) but LRH can also be considered in patient with initial open liver resection (OLR). The aim of this study was to evaluate the outcome of RH following primary LLR or OLR. Methods: Patients who underwent LRH after initial LLR or OLR were retrieved from prospective data bases at Paul Brousse and Henri Mondor hospitals. The patients were divided into two groups according to their initial hepatectomy, laparoscopic liver resection group (group 1) or open liver resection group (group 2). Results: Twenty-seven patients matched the inclusion criteria. 21 were in group 1 and 6 patients in group 2. Diagnoses were HCC 16 cases (59%), CRLM or other mets in 9 (33.3%) or other in 2 (8%). There were no conversions in group 1 and 1 in group 2 (16.7%). No significant differences were observed in mean operative time (187 vs 239 minutes; p=0.397) and mean blood loss (203 vs 175 ml; p=0.575). No transfusions were needed in both groups. One patient died in group 2 of postoperative pancreatitis; this patient had been converted during repeat hepatectomy. Morbidity rates were 23% and 16%, respectively (NS). All complications except for the patient who died were classified as 2 or less according to Clavien classification. Hospital stay was 4.5 and 6.7 days respectively (p=0.23). R1 resection in 14% and 33%, respectively (p=0.5). Conclusion: This study confirms that LRH after both LLR and OLR is safe and efficient. No differences were found whether initial surgery was done laparoscopically or open, however, the high rate of R1 resections after initial open resection and one patient’s death suggests caution and strict patient selection.