Outcomes of laparoscopic repeat liver resection for recurrent liver cancer

Abstract

Background:With the improvements of surgical instruments and surgeons’ experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer.Methods:A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data.Results:A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: −33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = −187.33 mL; 95%CI: −249.62 to −125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06–1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23–0.76; P = .004), and shorter hospital stays (WMD = −2.31; 95%CI: −3.55 to −1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99–114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups.Conclusions:LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.

Laparoscopic hepatectomy for treating recurrent Intrahepatic bile duct stones: A review and meta-analysis

“…However, the high postoperative recurrence rate and residual stone rate of intrahepatic bile duct stones, and there is no effective method to prevent postoperative recurrence, making hepatolithiasis become a refractory disease in biliary surgery.Research shows that after surgical treatment of patients with hepatolith 8 years, the recurrence rate is as high as 30.9% [10], which means that most patients often require again even surgical treatment for many times. But,the history of intra-abdominal surgery has been considered a relative contraindication for laparoscopic surgery during the early years of use [11].Although previous studies had shown that laparoscopic repetitive liver resection is safe and feasible in patients with a history of upper abdominal surgery or even a history of hepatectomy, these studies rarely involve the disease of IHD [12][13][14].Patients with IHD usually have perihepatic adhesions, anatomic distortion of the hilar area and intrahepatic biliary structure, and brotic parenchyma,biliary cirrhosis and portal hypertension that may increase the operative di culty and risk of complications.This requires the operator to be highly skilled in laparoscopy and surgery.Therefore, for the choice of surgical methods for patients with recurrent hepatolithiasis, the vast majority of doctors still choose the more conservative traditional open surgery.The opposite is that Most patients have great fear of traditional surgery and often refuse to have another operation, which leads to deterioration of the condition and seriously affects the physical and mental health of the patients [15,16].With the popularization of minimally invasive concept, more and more patients are eager to get minimally invasive treatment.Whether patients with recurrent intrahepatic bile duct stones can undergo laparoscopic hepatectomy has become an urgent question to be answered.…”

Current status of laparoscopic repeat liver resection for hepatocellular carcinoma

“…Besides our study, the studies include patients with other diseases than HCC with few data for long-term results. However, adding of only a few existing metaanalyses [34,35] , they all mentioned that LRLR for selected patients is feasible with, at least, comparable results to open procedure.…”

The predictive value of vessels encapsulating tumor clusters in treatment optimization for recurrent early‐stage hepatocellular carcinoma

“…In addition, radiofrequency ablation (RFA), a minimally invasive option, has emerged as another alternative treatment modality for early‐stage HCC 9,10 . Several studies have previously recommended RHR when possible in the treatment of recurrent HCC 11–13 . However, conflicting data have shown that RFA, with relatively few complications, could achieve survival outcomes comparable to those of RHR for recurrent early‐stage HCC 14–16 .…”