Clinical Analysis Of Laparoscopic Repeat Hepatectomy For Recurrent Liver Cancer

IntroductionRepeat hepatectomy(RH)is one of the most effective treatments of recurrent liver cancer and metastatic liver cancer.Laparoscopic repeat hepatectomy(LRH)is considered to be a technically challenging procedure.The aim of this study was to evaluate the feasibility and safety of LRH for patients with recurrent liver cancer.MethodsAll data of patients who underwent laparoscopic repeated hepatectomy was included in the department of General surgery,Sir Run Run Shaw Hospital from January 2010 to April 2019.Exclusion criteria:1)patients with identified extrahepatic metastasis;2)surgery only for laparoscopic exploration;3)the major vessels were invaded;4)patients with poor cardiopulmonary function and will not tolerate the surgery.According to the different methods of repeat hepatectomy,the patients were divided into laparoscopic repeat hepatectomy(LRH)group and open repeat hepatectomy(ORH)group.LRHs were matched to ORHs(1:1)using Propensity Score Matching(PSM)created by comparing pre-operative factors.The preoperative,intraoperative and postoperative data of patients were retrospectively collected and analyzed,including demographic data,tumor characteristics,operative time,intraoperative blood loss,complication rate and mortality within 30 days,length of postoperative stay,postoperative pathology.Meanwhile,subgroup analysis was conducted for LRH.According to the primary surgical strategy,patients of LRH group were divided into Primary Laparoscopic Hepatectomy(PLH)group and Primary Open Hepatectomy(POH)group and the perioperative data were retrospectively analyzed.ResultsBetween January 2010 to April 2019,a total of 63 patients with recurrent HCC underwent repeated hepatectomy were selected,including 39 patients in the LRH group and 24 patients in the ORH group.One patient underwent conversion because of tumor invasion of common hepatic duct and two patients underwent conversion due to the severe postoperative adhesions and difficulty in tumor exposure respectively in the LRH group.After propensity score matching(1:1),a cumulative total of 34 patients were enrolled in this study,with 17 patients assigned to LRH group and ORH group equally.In terms of demographic data,in the LRH group,the male to female ratio was 14:3 and the average age of the patients was 64(64-66)years old,and the BMI was(22.8±4.3)kg/m2.Thirteen patients had a history of hepatitis B;In the ORH group,the male to female ratio was 14:3,the average age of the patients was 59(55-59)years old,and the BMI was(23.1±3.9)kg/m2.Fifteen patients had a history of hepatitis B.There was no significant difference in demographic data and tumor characteristics between the two groups.In the LRH group,the average operation time of patients was(179.1 ± 89.6)min,and the mean intraoperative blood loss was 100.0(50.0-199.5)ml.Three patients received blood transfusion and Pringle maneuver was employed for four patients.The mean length of postoperative hospital stay was 5.0(4.5-8.0)days;the LRH group.The ORH group shows the average operation time was(226.9 ± 95.7)min and the mean intraoperative blood loss was 300.0(175.0-900.0)ml.Ten patients received blood transfusion and Pringle maneuver was applied for six patients.The mean length of postoperative hospital stay was 11.0(9.0-37.0)days.The intraoperative blood loss in the LRH group was significantly lower than that in the ORH group(P <0.01);The intraoperative blood transfusion rate in the LRH group was significantly lower(P =0.03);There was a notable reduction in LPM group postoperative in hospital stays(P<0.01).No significant differences were observed in other indicators.The subgroup analysis of the LRH group showed that there were no significant statistical differences between the primary laparoscopic hepatectomy(PLH)group and the primary open hepatectomy(POH)group in all perioperative data.ConclusionsLaparoscopic repeated hepatectomy is technically safe and feasible.LRH can effectively reduce intraoperative bleeding and postoperative hospital stay.For hepatopancreatobiliary centers with extensive experience in laparoscopic hepatectomy,LRH is also suitable for patients with previous open hepatectomy history.