Laparoscopic repeat liver resection for hepatocellular carcinoma: a multicentre propensity score-based study
Zenichi Morise, Luca Aldrighetti, Giulio Belli, Francesca Ratti, Andrea Belli, Daniel Cherqui, Minoru Tanabe, Go Wakabayashi, T T Cheung, Chung Mau Lo, Shogo Tanaka, Shoji Kubo, Yukiyasu Okamura, Katsuhiko Uesaka, Kazuteru Monden, Hiroshi Sadamori, Keisuke Hashida, K. Kawamoto, Naoto Gotohda, K H Chen, Akishige Kanazawa, Yutaka Takeda, Yoshiaki Ohmura, Masaki Ueno, Toshiro Ogura, Kyung‐Suk Suh, Yutaro Kato, Atsushi Sugioka, Hiroyuki Nitta, Masafumi Yasunaga, N A Halium, Alexis Laurent, H Kaneko, Yuichiro Otsuka, Ki Hyun Kim, H Cho, Charles Lin, Yusuke Ome, Yasuji Seyama, Roberto Troisi, Giammauro Berardi, F Roteller, Guy C. Wilson, David A. Geller, Olivier Soubrane, Tomoaki Yoh, Takashi Kaizu, Yusuke Kumamoto, HS Han, Ela Ekmekcigil, Ibrahim Dagher, David Fuks, Brice Gayet, Joseph F. Buell, R Ciria, Juan Briceño, Nicholas O’Rourke, Joel Lewin, Bjørn Edwin, Masahiro Shinoda, Yuta Abe, Mohammad Abu Hilal, Mohammad Alzoubi
Abstract
BACKGROUND: In the absence of randomized controlled data and even propensity-matched data, indications for, and outcomes of, laparoscopic repeat liver resection for hepatocellular carcinoma (HCC) remain uncertain. This study aimed to clarify the current indications for laparoscopic repeat liver resection for HCC, and to evaluate outcomes. METHODS: Forty-two liver surgery centres around the world registered patients who underwent repeat liver resection for HCC. Patient characteristics, preoperative liver function, tumour characteristics, surgical method, and short- and long-term outcomes were recorded. RESULTS: Analyses showed that the laparoscopic procedure was generally used in patients with relatively poor performance status and liver function, but favourable tumour characteristics. Intraoperative blood loss (mean(s.d.) 254(551) versus 748(1128) ml; P < 0·001), duration of operation (248(156) versus 285(167) min; P < 0·001), morbidity (12·7 versus 18·1 per cent; P = 0·006) and duration of postoperative hospital stay (10·1(14·3) versus 11·8(11·8) days; P = 0·013) were significantly reduced for laparoscopic compared with open procedures, whereas survival time was comparable (median 10·04 versus 8·94 years; P = 0·297). Propensity score matching showed that laparoscopic repeat liver resection for HCC resulted in less intraoperative blood loss (268(730) versus 497(784) ml; P = 0·001) and a longer operation time (272(187) versus 232(129); P = 0·007) than the open approach, and similar survival time (12·55 versus 8·94 years; P = 0·086). CONCLUSION: Laparoscopic repeat liver resection is feasible in selected patients with recurrent HCC.