Repeat liver surgery by laparoscopy for a malignant recurrence after previous open or laparoscopic resection

Abstract

Aim: This paper reported the experience of one center on repeat laparoscopic liver surgery for metastasis and hepatocellular carcinoma (HCC) with a review of the literature.

Methods: This retrospective study included 24 patients who underwent laparoscopic re-intervention (hepatic resection and radiofrequency ablation) for recurrent HCC in cirrhosis (n = 17) and for recurrent malignant metastases (n = 7) after a previous open or laparoscopic procedure. Patients were divided into two groups according to the first surgical approach. Group 1 underwent open resection and laparoscopic procedure (7 patients), and Group 2 underwent laparoscopic resection and laparoscopic procedure (17 patients).

Results: Mean operative time for re-intervention was significantly longer for Group 1 (220.14 ± 80.06 min) than for Group 2 (150 ± 56.18 min; P = 0.001), whereas the mean blood loss and mean hospital stay were comparable in both groups. According to Dindo-Clavien classification, overall morbidity ranged between Grade I and IIIa and was similar in both groups.

Conclusion: This study suggests that repeat laparoscopic surgery for recurrent hepatic malignant diseases in selected patients is a feasible and safe procedure with good short-term outcomes, but further prospective studies are needed to support these results.

Keywords

Recurrence / repeat liver surgery / resection

References

[1] Fong Y,Cohen A,Brennan MF.Repeat hepatic resections for metastatic colorectal cancer..Ann Surg1994;220:657-62 PMCID:PMC1234454

[2] Tuttle TM,Roh MS.Repeat hepatic resection as effective treatment of recurrent colorectal liver metastases..Ann Surg Oncol1997;4:125-30

[3] Petrowsky H,Jarnagin W,DeMatteo R,Blumgart L.Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis..Ann Surg2002;235:863-71 PMCID:PMC1422517

[4] Ishiguro S,Fujimoto Y,Sakamoto Y,Shimada K,Yamamoto S,Moriya Y.Second hepatectomy for recurrent colorectal liver metastasis: analysis of preoperative prognostic factors..Ann Surg Oncol2006;13:1579-87

[5] Wicherts DA,Salloum C,Pascal G,Adam R,Azoulay D.Repeat hepatectomy for recurrent colorectal metastases..Br J Surg2013;100:808-18

[6] Belli G1,Fantini C,Russo G,Belli A.Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results..Surg Endosc2009;23:1807-11

[7] Belli G,D'Agostino A,Limongelli P,Belli A.Laparoscopic segment VI liver resection using a left lateral decubitus position: a personal modified technique..J Gastrointest Surg2008;12:2221-6

[8] Belli G,Russo G,D'Agostino A,Belli A.Laparoscopic resection of recurrent hepatocellular carcinoma..In: Asbun HJ, Geller DA. ACS Multimedia Atlas of Surgery: Liver Surgery Volume. Woodbury: Ciné-Med; 2014. ACSV4-36

[9] Belli G,Fantini C,Belli A,Langella S.Laparoscopic radiofrequency ablation combined with laparoscopic liver resection for more than one HCC on cirrhosis..Surg Laparosc Endosc Percutan Tech2007;17:331-4

[10] Becker JM,Fazio VW,Stryker SJ,Wolff BG,Smith LE,Moore M.Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study..J Am Coll Surg1996;183:297-306

[11] Dindo D,Clavien PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey..Ann Surg2004;240:205-13 PMCID:PMC1360123

[12] Poon RT,Lo CM,Liu CL,Wong J.Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years..Ann Surg2001;234:63-70 PMCID:PMC1421949

[13] Tang ZY.Hepatocellular carcinoma - cause, treatment and metastasis..World J Gastroenterol2001;7:445-54 PMCID:PMC4688653

[14] Homayounfar K,Conradi LC,Lorf T,Sahlmann CO,Liersch T.Metastatic recurrence after complete resection of colorectal liver metastases: impact of surgery and chemotherapy on survival..Int J Colorectal Dis2013;28:1009-17 PMCID:PMC3712136

[15] Liang X,Yu H,Liang YL.Second laparoscopic resection for recurrent hepatocellular carcinoma after initial laparoscopic hepatectomy: case report..Chin Med J (Engl)2009;122:1359-60

[16] Cheung TT,Poon RT,Lo CM.A case of laparoscopic hepatectomy for recurrent hepatocellular carcinoma..World J Gastroenterol2010;16:526-30 PMCID:PMC2811811

[17] Hu M,Xu D.Laparoscopic repeat resection of recurrent hepatocellular carcinoma..World J Surg2011;35:648-55

[18] Shafaee Z,Marvin MR,Buell JF,Gayet B.Is laparoscopic repeat hepatectomy feasible? A tri-institutional analysis..J Am Coll Surg2011;212:171-9

[19] Nakahira S,Kawashima H,Hamanaka M,Uchiyama C,Takeno A,Nakata K,Okamura S,Tamura S.Pure laparoscopic surgery for repeat hepatectomy..Gan To Kagaku Ryoho2011;38:2478-80

[20] Tsuchiya M,Maeda T,Tamura A.Efficacy of laparoscopic surgery for recurrent hepatocellular carcinoma..Hepatogastroenterology2012;59:1333-7

[21] Kanazawa A,Shimizu S,Yamamoto S,Ohira G.Laparoscopic liver resection for treating recurrent hepatocellular carcinoma..J Hepatobiliary Pancreat Sci2013;20:512-7

[22] Shelat VG,Samim M,Al Saati H,Pearce NW.Outcomes of repeat laparoscopic liver resection compared to the primary resection..World J Surg2014;38:3175-80

[23] Belli G,D'Agostino A,Russo G,Limongelli P.Laparoendoscopic single site liver resection for recurrent hepatocellular carcinoma in cirrhosis: first technical note..Surg Laparosc Endosc Percutan Tech2011;21:e166-8

[24] Belli G,Fantini C,Belli A,Langella S.Laparoscopic incisional and umbilical hernia repair in cirrhotic patients..Surg Laparosc Endosc Percutan Tech2006;16:330-3