Current status of laparoscopic repeat liver resection for hepatocellular carcinoma

Although liver resection (LR) is often adopted to recurrent hepatocellular carcinomas, risks of complications and conversion reportedly increase in laparoscopic repeat LR (LRLR). The indication is not agreed upon even with the recent advances of laparoscopic LR. We conducted an international propensity score matching study of LRLR and open repeat LR for hepatocellular carcinoma with 1,582 patients from 42 world centers. Propensity-score matched LRLR patients have smaller blood loss and longer operation time than open repeat LR patients. Median overall survival time was 8.94 years in open and 12.55 years in LRLR; although the difference was not significant, the P-value was 0.0855 and the better curve of LRLR is clearly separated from that of open. In our institution, we experienced 34 LRLR and 12 cases of three times or more repeat LR until 2019. There are no significant differences in operation time, blood loss, hospital stay, conversion, and morbidity rates among first, second, and third or higher laparoscopic LR, which is different from the open situation. However, postoperative bile leakage and intraoperative bleeding causing conversion did happen in the cases with repeat extended exposure of Glissonian pedicle. LRLR is feasible for selected patients. However, the procedure is under developing stage and further accumulation of experiences and evaluation are needed.