Laparoscopic Repeat Hepatectomy Research Articles

Appropriate indications for laparoscopic repeat hepatectomy

BackgroundLaparoscopic repeat hepatectomy (LRH) has increased, but appropriate indications for LRH are unclear. This study aimed to clarify appropriate indications for LRH.MethodsWe retrospectively compared surgical outcomes between open RH (ORH) (n = 57) and LRH (n = 40) groups. To detect difficult cases of complete pure LRH, we examined patients with unplanned intraoperative hand-assisted laparoscopic surgery (HALS)/open conversion (n = 6).ResultsIn the LRH versus ORH group, as previous hepatectomy, laparoscopic (75% vs. 12%, p < 0.001) and partial hepatectomy (Hr0) (73% vs. 37%, p = 0.002) were more frequently performed, and as RH procedure, partial hepatectomy (Hr0) (88% vs. 47%, p = 0.0002) was more frequently performed. S1 tumor cases were higher in ORH group (11% vs. 0%), but S2-6 cases were higher in LRH group (73% vs. 49%) (p = 0.02). In LRH group, compared to the pure LRH patients, HALS/open conversion patients underwent significantly more previous hepatectomy with more than lobectomy (Hr2-3) (33% vs. 2.9%, p = 0.033) and more RH procedures with segmentectomy (HrS) (33% vs. 2.9%, p = 0.03). All LRH requiring a repeat hepatic hilar approach were HALS conversions.ConclusionAppropriate indications for LRH were previous hepatectomy was laparoscopic partial hepatectomy (Hr0), and RH procedure was partial hepatectomy (Hr0) for S2-6 tumor location. When RH is more than segmentectomy (HrS) requiring a repeat hepatic hilar approach, planned HALS or ORH may be a better approach than pure LRH.

Advantages of the Laparoscopic Approach for the Initial Operation in Patients who Underwent Repeat Hepatectomy

BackgroundLess intra-abdominal adhesions are expected following laparoscopic surgery. Although an initial laparoscopic approach for primary liver tumors may have advantages in patients who require repeat hepatectomies for recurrent liver tumors, this has not been sufficiently investigated. MethodsPatients who underwent repeat hepatectomies for recurrent liver tumors at our hospital between 2010 and 2022 were retrospectively analyzed. Of 127 patients, 76 underwent laparoscopic repeat hepatectomy (LRH), of whom 34 patients initially underwent laparoscopic hepatectomy (L-LRH) and 42, open hepatectomy (O-LRH). Fifty-one patients underwent open hepatectomy as both the initial and second operation (O-ORH). We analyzed surgical outcomes between L-LRH and O-LRH groups and between L-LRH and O-ORH groups using propensity-matching analysis for each pattern. ResultsTwenty-one patients each were included in L-LRH and O-LRH propensity-matched cohorts. The L-LRH group had a lower rate of postoperative complications than the O-LRH group (0 vs 19%, P = 0.036). When we compared surgical outcomes between L-LRH and O-ORH groups in another matched cohort with 18 patients in each group, in addition to the lower rate of postoperative complications, the L-LRH group had additional favorable surgical outcomes including shorter operation time and lower blood loss volume than the O-ORH group (291 vs 368 min, P = 0.037 and 10 vs 485 mL, P < 0.0001). ConclusionsAn initial laparoscopic approach would be favorable for patients undergoing repeat hepatectomies, as it leads to lower risk of postoperative complications. Compared with O-ORH, the advantage of the laparoscopic approach may be enhanced when it is repeatedly adopted.

Laparoscopic versus open repeat hepatectomy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched cohort studies.

The effectiveness of laparoscopic repeat hepatectomy (LRH) versus open repeat hepatectomy (ORH) on recurrent hepatocellular carcinoma (RHCC) is unclear. We compared the surgical and oncological outcomes of LRH and ORH in patients with RHCC with a meta-analysis of studies based on propensity score-matched cohorts. A literature search was conducted on PubMed, Embase, and Cochrane Library with Medical Subject Headings terms and keywords until 30 September 2022. The quality of eligible studies was evaluated with the Newcastle-Ottawa Scale. Mean difference (MD) with a 95% CI was used for the analysis of continuous variables; odds ratio (OR) with 95% CI was used for binary variables; and hazard ratio with 95% CI was used for survival analysis. A random-effects model was used for meta-analysis. Five high-quality retrospective studies with 818 patients were included; 409 patients (50%) were treated with LRH and 409 (50%) with ORH. In most surgical outcomes, LRH was superior to ORH: less estimated blood loss, shorter operation time, lower major complication rate, and shorter length of hospital stay (MD=-225.9, 95% CI=[-360.8 to -91.06], P =0.001; MD=66.2, 95% CI=[5.28-127.1], P =0.03; OR=0.18, 95% CI=[0.05-0.57], P =0.004; MD=-6.22, 95% CI=[-9.78 to -2.67], P =0.0006). There were no significant differences in the remaining surgical outcomes: blood transfusion rate and overall complication rate. In oncological outcomes, LRH and ORH were not significantly different in 1-year, 3-year, and 5-year overall survival and disease-free survival. For patients with RHCC, most surgical outcomes with LRH were superior to those of ORH, but oncological outcomes with the two operations were similar. LRH may be a preferable option for the treatment of RHCC.

Efficacy of laparoscopic repeat hepatectomy compared with open repeat hepatectomy: a single-center, propensity score matching study

IntroductionLaparoscopic repeat hepatectomy (LRH) is considered to be a technically challenging procedure which has not been widely applied. This study aimed to assess the accessibility and security of LRH for patients with hepatic tumor recurrence.MethodsBetween January 2010 and October 2020, we performed 48 LRHs and 31 open repeat hepatectomies (ORHs) for recurrent liver cancer. LRHs were matched to ORHs (1:1) using propensity score matching (PSM) created by comparing preoperative factors. The perioperative data of patients were retrospectively analyzed, including baseline data, operative time, intraoperative blood loss, pathology, days of postoperative stay, complication morbidity, and mortality within 30 days. Overall survival and recurrence-free survival rates with appropriate follow-up were obtained to evaluate the long-term outcomes.ResultsCompared with the ORH, LRH was related with shorter operative duration (169.9 versus 232.9 ml, p < 0.01), less intraoperative bleeding (100.0 versus 500.0 ml, p < 0.01), lower rate of blood transfusion (8.3% versus 58.1%, p < 0.01), and shorter hospitalization (5.0 versus 11.0 days, p < 0.01). The median follow-up was 31 months. The LRH 1-, 3-, and 5-year overall survival were 77.1%, 61.6%, and 46.2% versus 82.3%, 66.5%, and 29.5% for ORH (p = 0.77). The 1-, 3-, and 5-year disease-free survival rates of the two groups were 73.4%, 62.0%, and 44.3% versus 66.1%, 44.1%, and 14.7%, respectively (p = 0.22).ConclusionsLaparoscopic repeated hepatectomy is safe and practicable with great short-term results for selected patients.

Laparoscopic vs open liver re-resection for cirrhotic patients with post-hepatectomy hepatocellular carcinoma recurrence: A comparative study.

BACKGROUNDRepeated liver resection is an effective treatment for recurrent hepatocellular carcinoma (HCC). However, few studies have compared the outcome of laparoscopic repeat hepatectomy (LRH) and open repeat hepatectomy (ORH) for recurrent HCC, and few of those have included cirrhotic patients.AIMTo compare short-term and long-term outcomes of cirrhotic patients with LRH and ORH for recurrent HCC.METHODSWe retrospectively analysed the clinical records retrieved from a prospectively collected database of all patients who underwent hepatectomy for post-hepatectomy recurrent HCC at our institute between May 2006 and June 2021. Cases of recurrent HCCs larger than 7 cm were excluded. Patient demographics, operative details, perioperative outcomes, pathologic details, disease-free survival (DFS), and overall survival (OS) data of LRH and ORH were compared.RESULTSData from 29 patients with LRH and 22 with ORH were compared. The LRH group showed significantly better outcomes for blood loss (median 300 mL vs 750 mL, P = 0.013) and length of hospital stay (median 5 d vs 7 d, P = 0.003). The 1-, 3- and 5-year OS rates in the LRH group were 100.0%, 60.0% and 30.0%, respectively; the corresponding rates in the ORH group were 81.8%, 36.4% and 18.2% (P = 0.336). The 1-, 3- and 5-year DFS rates in the LRH group were 68.2%, 27.3% and 4.5%, respectively; the corresponding rates in the ORH group were 31.3%, 6.3% and 6.3% (P = 0.055). There were no significant differences in overall and DFS between the two groups.CONCLUSIONLaparoscopic re-resection should be considered for patients presenting with recurrent HCC less than or equal to 7 cm after previous hepatectomy.

Laparoscopic repeat hepatectomy for recurrent hepatocellular carcinoma from segment 1 to 8: Is it a feasible treatment strategy?

Laparoscopic liver resection for hepatocellular carcinoma (HCC) is becoming the primary option for expert surgeons and high volume centers. However, repeat liver resection for recurrent HCC is still not yet established. This study aims to determine the surgical outcomes with laparoscopic repeat liver resection (LRLR) vs. open repeat liver resection (ORLR) for recurrent HCC. Fifty cases of repeat liver resection was done in our center since January 2009 to November 2020. The repeat surgery was performed under LRLR group for 23 patients and ORLR group for 27 patients. The surgical outcomes were studied retrospectively. We had 2 (8.6%) open conversion secondary to bleeding and severe adhesion from previous surgery. Most of the LRLR, 17 (73.9%) patients had primary laparoscopic liver resection. The LRLR had shorter operative time (mean 159.74 vs. 250.19 minutes; p ≤ 0.001), lesser intraoperative blood loss (mean 185.65 vs. 385.56 mL; p = 0.037), lower morbidity (8.6% vs. 62.9%; p ≤ 0.001) and shorter hospital stay (mean 5.83 vs. 9.26 days; p ≤ 0.001) compared with ORLR. There was no significant difference in the R0 resection and surgical margin between the two groups. LRLR is feasible and safe for highly selective patients. With the expert surgeons and in high volume centers, LRLR offers betters perioperative outcomes without compromising oncologic benefits compared with ORLR.

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score-Matched Study and Meta-Analysis.

Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

Does repeat laparoscopic hepatectomy without extracorporeal Pringle manoeuvre worsen treatment outcomes?

IntroductionThe Pringle manoeuvre is used in most hospitals to counteract intraoperative haemorrhage in laparoscopic hepatectomy by occluding the flow of blood to the liver. However, in laparoscopic repeat hepatectomy (LRH), outcomes of previous surgery and the influence of other factors frequently make it difficult to occlude the inflow of blood.AimTo discuss the value of inflow occlusion during LRH and provide tips for its performance.Material and methodsSixty-three patients who underwent LRH with or without the Pringle manoeuvre were analysed retrospectively. We investigated the efficacy and safety of the Pringle manoeuvre in LRH. Student’s t and χ2 tests, Mann-Whitney’s U test, Wilcoxon’s signed-rank test, and Fisher’s exact test were used in the statistical analysis.ResultsNineteen patients underwent LRH with the Pringle manoeuvre, and 44 patients underwent LHR without the Pringle manoeuvre. After propensity score matching, there were no significant differences in terms of operative time, estimated blood loss, and postoperative complication rate (p = 0.973, 0.120, and not applicable, respectively). However, the rate of conversion to open repeat hepatectomy (ORH) was significantly lower in the Pringle manoeuvre group (p = 0.034). In many cases, the cause of conversion to ORH was the non-use of inflow occlusion and the resulting inability to control intraoperative haemorrhage. Laboratory data collected after surgery showed no significant difference between the 2 groups regardless of whether blood flow was occluded or not.ConclusionsLRH with the Pringle manoeuvre can be performed safely using various surgical devices. However, it is often challenging to perform the Pringle manoeuvre in patients with a history of cholecystectomy or segment 5 resection of the liver, and caution is required.

Short-Term Outcomes of Laparoscopic Repeat Hepatectomy

Background: Although repeat hepatectomy is an effective treatment for recurrence hepatocellular carcinoma and metastatic liver tumor, laparoscopic repeat hepatectomy (LRH) is not widely accepted and its indication has not been established. The aim of this study was to clarify feasibility and safety of LRH. Methods: Seventy-eight patients who underwent repeat hepatectomy from January 2013 to December 2019 were retrospectively reviewed. Short-term outcomes of LHR and open repeat hepatectomy (ORH) were investigated. Result: LRH and ORH were applied for 42 (53.8%) and 36 (46.2%) patients, respectively. Among LRH group, conversions to open surgery including mini laparotomy were needed for 4 patients (9.5%) due to severe adhesion (n=2) and tumor status (n=2). As compared to ORH group, number of tumors was small (median 1 vs. 2; P=0.0003), tumor size was small (median 1.95 vs. 2.45; P=0.0388) in LRH group. Previous open hepatectomy had undergone for 9 patients (21.4%) in LRH group and 27 patients (75.0%) in ORH group (P< 0.0001). Liver resection more than 2 Couinaud`s segment was performed for 21.4% in LRH group and 78.5% in ORH group (P=0.25). There was no significant difference in operation time and postoperative complication rate between two groups. Intraoperative blood loss was smaller (median 60 ml vs. 310 ml; P< 0.0001) and postoperative hospital stay was shorter (median 7 days vs. 9 days; P< 0.0001) in LRH group. Conclusion: LHR is feasible and safety option for patient with recurrent liver tumors.

Laparoscopic repeat hepatectomy is a more favorable treatment than open repeat hepatectomy for contralateral recurrent hepatocellular carcinoma cases.

We compared surgical outcomes, with a focus on tumor characteristics, of laparoscopic repeat hepatectomy (LRH) and open repeat hepatectomy (ORH) to identify recurrent hepatocellular carcinoma (HCC) cases where the LRH procedure would be more favorable than ORH. Eighty-one HCC patients who underwent repeat hepatectomy in our hospital from 2008 to 2019 were retrospectively analyzed in this study. Of these patients, 30 and 51 patients underwent LRH and ORH, respectively. We analyzed surgical outcomes of LRH and ORH, focusing on tumor characteristics such as tumor size, location, distance from major vessels, and contralateral or ipsilateral tumor recurrence to determine what factors could affect surgical outcomes. Subsequently, using a propensity-matched cohort, we compared the impact of those factors on LRH and ORH outcomes. In the entire cohort, the LRH operation time was significantly shorter in contralateral recurrent HCC cases than in ipsilateral recurrent HCC cases (252 vs. 398min, P = 0.008); however, such a difference was not observed in the ORH operation time. We subsequently compared the surgical outcomes, in terms of the location of tumor recurrence, between the LRH and ORH groups in a propensity-matched cohort. In total, 23 patients were included in each of these groups. We found that the LRH procedure had significantly shorter operative time than the ORH procedure in the contralateral recurrent HCC cases (253 vs. 391min, P = 0.018); however, we did not observe such a difference in the ipsilateral recurrent HCC cases (372 vs. 333min, P = 0.669). LRH had lower blood loss, similar postoperative complications and shorter hospital stay than ORH in both contralateral and ipsilateral recurrent HCC cases. LRH is likely considered a more favorable approach than ORH in treating patients with contralateral recurrent HCC.

Hand-assisted Laparoscopic Repeat Hepatectomy for Secondary Liver Neoplasm.

Hand-assisted laparoscopic surgery is a widely accepted alternative to an open approach. The use of this technique in repeat liver resection is limited due to technical difficulties caused by postsurgical adhesions. We aimed to assess the feasibility and safety of hand-assisted laparoscopic repeat hepatectomy (HALRH). This was a retrospective study of the medical files of patients who had undergone HALRH between 2010 and 2017 in 2 university-affiliated medical centers. Sixteen patients with repeat hepatectomy were included with a median age of 67.5 years. The first liver resection was a traditional laparotomy for 9 patients and hand-assisted laparoscopic surgery for 7 patients. The conversion rate to open surgery was 6%. The median operative time, blood loss during surgery, and postoperative hospital stay were 166 minutes, 400 mL, and 7 days, respectively. R0 resections were achieved in 88% of patients. The median number of tumors and tumor size were 1 and of 25 mm, respectively. There were no mortalities or major complications postoperatively. For patients with colorectal liver metastases, the median follow-up and overall survival were 21 and 43 months, respectively. The findings suggest HALRH to be safe and feasible. Future ERAS guidelines should evaluate this approach for liver surgery.

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

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.

Learning curve in laparoscopic liver surgery: A single-surgeon risk-adjusted CUSUM analysis for postoperative complications of the first 320 laparoscopic liver resections

Background: The Learning curve and the amount of procedures required to reach the 'mastery phase' in laparoscopic liver resections(LLR) are unknown. This study aimed to evaluate the short-term outcomes and investigate the learning curve(LC) during the first 320LLR performed by a single surgeon. Materials & Methods: Retrospective review of a prospective database of all patients who underwent LLR between October 2011 and November 2018. The IWATE Difficulty Score(IDS) was used to calculate a logistic regression risk model do adjust CUSUM for postoperative complications. Results: During 7years, 320/480 liver resections (66.7%) were performed by a pure laparoscopic approach. During these years, percentage of LLR increased from 45.0% to 69.2%(p=0.33). Malignancy was present in 275/320LLL (85.9%). Laparoscopic repeat hepatectomy was performed in 45/320(14.1%) cases. Median blood loss was 100ml(IQR:50-250ml) and median operative time was 130min (IQR:90-180min). Conversion rate was 2.5% and blood transfusion rate was 2.8%. Major complication rate (Clavien-Dindo=III) was 3.1% with 0.94% 90-day mortality. R0 resection rate was 93.6%. The single-surgeon CUSUM LC for postoperative complications showed the presence of three phases: an initiation phase of approximately 50 cases,an intermediate phase and a mastery phase beginning at approximately 140procedures. Important differences were found in complication rates for patients with different IDS (3.4% in IDS=0 VS 39.1% in IDS=10). A risk-adjusted CUSUM (RA-CUSUM) analysis showed an initial learning phase of 20 procedures,a plateau phase and a mastery phase after 60 cases with very low complication rates after 100 procedures. Conclusion: Even after a dedicated fellowship, with excellent short-term outcomes in early experience, a learning curve is present in laparoscopic liver surgery. The mastery phase is reached at approximately 60 cases. CUSUM and RA-CUSUM have an important role in monitoring surgical outcomes. However, adjustment for patient mix is critical. Difficulty scores can be used to adjust the CUSUM chart for different patient characteristics that significantly afffect the risk. CUSUM and RA-CUSUM charts for postoperative complications

Novel patient risk factors and validation of a difficulty scoring system in laparoscopic repeat hepatectomy

The indications for laparoscopic liver resection have expanded; however, the safety and benefits of laparoscopic repeat hepatectomy (LRH) remain unclear. We retrospectively reviewed data from 137 patients who underwent partial hepatectomy or left lateral sectionectomy without thoracotomy. We compared patients’ clinical factors using a difficulty scoring system for LRH. We defined factors associated with blood loss volumes in the 75th percentile or above as risk factors for bleeding in open repeat hepatectomy, and determined whether these factors were useful for LRH risk assessment. Open repeat hepatectomy and LRH was performed in 96 and 41 patients, respectively. Four of 41 (9.8%) patients undergoing LRH were converted to laparotomy. Blood loss volume was significantly greater in the intermediate-risk group than in the low-risk group (P = 0.046). Multivariate analysis revealed that the presence of tumours located adjacent and caudal or dorsal to the primary tumour site was an independent risk factor for bleeding in LRH (odds ratio 3.21, 95% confidence interval 1.16–8.88, P = 0.024). Our study validated the usefulness of a difficulty scoring system, identified patient factors that predicted the difficulty of LRH, and presented a novel difficulty scoring system for LRH based on an existing difficulty scoring system.

Laparoscopic repeat hepatectomy for treating recurrent liver cancer.

Background:Laparoscopic repeat hepatectomy (LRH) is a technically challenging procedure, so LRH for recurrent liver cancer has not been widely accepted. The aim of this study was to perform a systematic review of the current literature to identify and evaluate available data of LRH for recurrent hepatocellular carcinoma (rHCC) and metastases tumour of liver, especially of colorectal liver metastases (CRLM), focusing on the safety and feasibility.Methods:A comprehensive search of the PubMed database was performed for all studies published in English evaluating LRH for rHCC and recurrent metastases tumour of liver from 1st January, 2005 to 1st June, 2019.Results:A total of 15 studies which comprised 444 patients and reported outcomes for the efficacy and safety of LRH in the treatment of rHCC or CRLM were included in the present review. Moreover, nine studies compared the perioperative outcomes of LRH versus open repeat hepatectomy (ORH). LRH was superior to ORH with reduced blood loss, shorter operative time, shorter hospital stay and lower morbidity rates.Conclusions:LRH can safely performed in rHCC or CRLM patients with cirrhosis, previous open hepatectomy, multiple recurrent lesions and tumours located in difficult posterosuperior segments.

Comparision between laparoscopic hepatectomy and open hepatectomy for recurrent hepatocellular carcinoma

Objective To compare the safety and short-term efficacy of laparoscopic repeat hepatectomy (LRH) with open repeat hepatectomy (ORH) for recurrent hepatocellular carcinoma (rHCC). Methods The clinical data of 33 patients with rHCC who underwent hepatectomy at Nanfang Hospital, Southern Medical University from August 2015 to November 2017 were retrospectively analyzed. There were 24 males and 9 females. The patients were divided into LRH group (n=15) and ORH group (n=18). The preoperative clinical data, operative and postoperative data of the two groups were compared. Results No significant differences were observed in the preoperative clinical data of the two groups, including the extent of the previous hepatectomy, the interval between the two surgeries, the number of tumors, and the maximum diameter of tumors. No significant differences were observed in the liver resection method, portal occlusion time and operation duration between the two groups. Blood loss was significantly lower in the LRH group [(66.7±86.1)ml vs. (251.1±75.6)ml, P 0.05). The postoperative diet recovery was significantly shorter (1.2±0.4) days vs. (2.9±1.4) days, the inflammation indicator NEU% was significantly decreased (83.6±4.8)% vs. (88.2±3.7)%, and the length of postoperative hospital stay (6.3±2.9) days vs. (9.8±3.7)days was significantly shorter in the LRH group (P<0.05). Conclusions LRH was safe and effective in the treatment of rHCC, LRH was superior in reducing intraoperative blood loss, promoting postoperative recovery and shortening hospital stay when compared to ORH. Key words: Hepatectomy; Carcinoma, hepatocellular; Recurrence; Laparoscopes

Surgical technique and short-term outcomes of laparoscopic repeat hepatectomy

Surgical technique and short-term outcomes of laparoscopic repeat hepatectomy

Laparoscopic hepatectomy for recurrent hepatocellular carcinoma after previous open hepatectomy

To evaluate the feasibility, safety and long-term outcomes of laparoscopic repeat hepatectomy for recurrent hepatocellular carcinoma (HCC) following previous resection. Between January 2003 and January 2011, 14 patients with recurrent HCC were carefully selected to undergo repeat laparoscopic hepatectomy, among which 9 patients were male, 5 patients were female, and the average age was 54 years. Prior to re-resection, all patients had undergone at least one open hepatectomy for HCC. The perioperative and long-term outcomes of these patients were retrospectively analyzed. Repeat laparoscopic hepatectomy for these 14 patients were successfully performed without major perioperative complications. The mean operative time, intraoperative blood loss and hospital stay were (124 ± 82) minutes, (112 ± 43) ml and (7 ± 4) days, respectively. The mean follow-up period was 23 months (range 14 to 42 months). At the time of follow-up, 11 patients were still alive, among which 3 patients developed recurrent disease and 8 patients remained disease free. One patient died of liver dysfunction at 21 months, and another 2 patients died of tumor recurrence at 17, 31 months, respectively. Laparoscopic surgery for recurrent HCC remains a viable option for repeat hepatectomy in selected patients who have undergone open hepatectomy.