Current status of laparoscopic repeat liver resection for recurrent hepatocellular carcinoma

Abstract

Repeat liver resection (RLR) is an effective treatment approach for recurrent hepatocellular carcinoma (HCC) and can provide acceptable long-term outcomes in select patients. Recent randomized controlled trials comparing RLR with radiofrequency ablation revealed that the latter approach was associated with a higher rate of early recurrence compared with RLR. With recent advances in laparoscopic liver resection (LLR), RLR has been increasingly performed using laparoscopy. Several propensity score-matched studies reported that laparoscopic RLR achieved lower blood loss and shorter hospital stays compared to open RLR. However, laparoscopic RLR requires more advanced techniques because of adhesions formed after the previous liver resection, changes in anatomical landmarks, and deformity of the remnant liver. The recently described difficulty classification of laparoscopic RLR is based on five factors including type of previous liver resection (open or laparoscopic), number of previous liver resections, surgical procedure used in previous liver resections, tumor location in previous liver resections, and difficulty score of LLR for recurrent HCC. We reviewed the available literature to summarize available evidence suggesting that laparoscopic RLR might be considered a more minimally invasive surgical treatment approach for recurrent HCC as long as the indication for laparoscopic RLR is carefully determined