Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 409-418
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.409
Laparoscopic vs open liver re-resection for cirrhotic patients with post-hepatectomy hepatocellular carcinoma recurrence: A comparative study
Kai-Chi Cheng, Kit-Man Ho
Kai-Chi Cheng, Kit-Man Ho, Department of Surgery, Kwong Wah Hospital, Hong Kong 999077, China
Author contributions: Cheng KC designed the research study, performed the research, analyzed the data and drafted the manuscript; Ho KM wrote and revised the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The protocol was approved by The Hong Kong Hospital Authority Research Ethics Committee (Kowloon Central/Kowloon East) (Ref: KC/KC-21-0278/ER-4) following the applicable laws and regulations (including Hong Kong laws), hospital authority policy, professional code of conduct, International Council for Harmonisation, Good Clinical Practice, and the Declaration of Helsinki.
Informed consent statement: Written consent was not required as this was a retrospective study, and no data were collected prospectively.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: The datasets generated during and/or analysed during the current study are not publicly available due to the potential that individual privacy could be compromised, but they are available in an anonymized form from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai-Chi Cheng, FRCS (Ed), Doctor, Department of Surgery, Kwong Wah Hospital, No. 25 Waterloo Road, Kowloon, Hong Kong 999077, China. thomascheng@hotmail.com
Received: December 30, 2021
Peer-review started: December 30, 2021
First decision: March 10, 2022
Revised: March 12, 2022
Accepted: April 26, 2022
Article in press: April 26, 2022
Published online: May 27, 2022
ARTICLE HIGHLIGHTS
Research background

Recurrent hepatocellular carcinoma can be effectively treated with repeated liver resection (HCC). For recurrent HCC, few studies have compared the outcomes of laparoscopic repeat hepatectomy (LRH) with open repeat hepatectomy (ORH), and even fewer have included cirrhotic patients.

Research motivation

Currently, there is a lack of evidence of the effectiveness of LRH for the treatment of recurrent HCC in cirrhotic patients.

Research objectives

This study aimed to compare the short-term and long-term outcomes for cirrhotic patients with LRH and ORH for recurrent HCC. The study was intended to provide insights on performing LRH for cirrhotic patients with recurrent HCC.

Research methods

A prospectively collected database identified all patients undergoing repeat hepatectomy for recurrent HCC between May 2006 and June 2021. Recurrent HCC with tumours > 7 cm were excluded. Patient demographics, operative details, perioperative outcomes, pathologic details, disease-free survival (DFS) and overall survival (OS) associated with LRH and ORH were compared.

Research results

Cirrhosis was histologically diagnosed in 62.7% of our patients and more than 90% were hepatitis B carriers. Blood loss (median 300 mL vs 200 mL, P = 0.013) and length of hospital stay (median 5 d vs 7 d, P = 0.003) were significantly better in the LRH group. There were no significant differences in the 1-, 3- and 5-year OS and DFS rates between the LRH and ORH groups.

Research conclusions

Even in patients with cirrhosis, laparoscopic liver resection for recurrent HCC was associated with decreased blood loss, a shorter hospital stay, and equivalent overall and DFS to open surgery.

Research perspectives

Laparoscopic re-resection should be considered for patients with recurrent HCC of less than or equal to 7 cm in size that develop subsequent to a previous hepatectomy. However, larger studies or randomised controlled trials should be conducted to confirm the advantages of LRH for the management of recurrent HCC.