Status and perspective of laparoscopic repeat liver resection

Table 1 Summary of previous reports of repeat laparoscopic liver resection

n	Disease	Previous LR(open:lap)	Procedure	Bleeding(mL)	Operating time (min)	Conversion(n)	Postoperative hospital stay (d)	Morbidity	Mortality	Ref.
12	HCC	4:8	LLS (n = 5), Pt (n = 4), Seg (n = 3)	297 ± 134 272.2 ± 120	114.4 ± 11.0 63.9 ± 13.3	1	7.4 ± 2.5 6.2 ± 3.0	26.60%	0%	[20]
2	Met	ND	ND	ND	ND	ND	ND	ND	ND	[21]
6	HCC	3:3 (Lap RFA, n = 2)	LLS (n = 2), Pt (n = 4)	283.3 ± 256.3	140.8 ± 35.7	0	5.67 ± 1.63	16.7%	0%	[24]
76	Met (n = 63), HCC (n = 3), others (n = 10)	28:44	LLS (n = 4), Pt, seg (n = 53), above-seg (n = 19)	300 (0–5000)	180 (80–570)	8	6 (2–42)	26%	0%	[23]
4	HCC (n = 3), Met (n =1)	0:4	LLS (n = 1), Pt (n = 3)	481.7 ± 449.5	312.3 ± 158.4	1	10.6 ± 7.4	23.4%	0%	[22]
3	HCC	0:3	ND	281.3 (mean)	264.6 (mean)	0	8.6 (mean)		0%	[26]
17	ND	ND	ND	ND	ND	ND	ND	ND	ND	[25]
20	HCC	15:5	Pt	78 (1–1500)	239 (69–658)	2 (HALS)	9 (5–22)	5%	0%	[27]
20	HCC (n = 2), Met (n = 16), others (n = 2)	0:20	Minor (n = 14), major (n = 6)	400 (IQR 150-200 mL)	285 (IQR 195-360)	3	4 (1-57)	10%	0%	[30]
12	HCC (n = 8), Met (n = 2), others (n = 2)	8:4	Pt (n = 9), Subseg (n = 3)	50 (NC–840)	301 (104–570)	0	12 (9–30)	0%	0%	[29]
11	HCC	6:5	LLS = 2 Subseg = 9	100 (50-500)	200 (131-352)	0	6 (3-17)	18.2%	0%	[33]
27	Met	ND	Major = 25 Minor = 2	ND (4 patients received transfusion)	252.5 (180-300)	1	9 (IQR 8-18)	48.1%	0%	[32]
8	HCC	6:2	Sec = 2 Seg = 2 Subseg = 4	200 (30-5000)	343 (120-530)	1	3.5 (3-8)	12.5%	0%	[31]
20	HCC (n = 15) Met (n = 5)	12:8	Anatomical = 1 Non-anatomical = 19	159 +/- 256	225 +/- 85	1	14.2 +/- 5.4	0%	0%	[19]
33	HCC and combined (n = 18) Met (n = 15)	21:12	Anatomical = 11 Non-anatomical = 22	30 (NC-1012)	217 (43-356)	0	6.5 (3-47)	6.1%	3%	[18]

Data are expressed as median (range) or mean ± SD, unless stated otherwise. In the paper from Belli, operation time, bleeding and postoperative hospital stay are described separately for patients whose previous hepatectomy was open (upper) or laparoscopic (lower). LLR: Laparoscopic liver resection; LR: Liver resection; HCC: Hepatocellular carcinoma; LLS: Left lateral sectorectomy; Met: Metastasis; Minor: Resection of 2 segments or less; Major: Resection of 3 segments or more; ND: Not documented; Pt: Partial resection; Sec: Sectionectomy; Seg: Segmentectomy; Subseg: Subsegmentectomy; IQR: Interquartile range; NC: Not countable.

Table 2 The summary of present status and future perspectives of repeat laparoscopic liver resection

Present status
There are 16 reports of small series. Controversy still exists in the indication of repeat LLR
These studies generally reported that it has better short-term outcomes without compromising the long-term outcomes (similar or longer operation time, reduces bleedings, reduced blood transfusion rate, less or similar morbidity and shorter hospital stay)
It facilitates more meticulous dissection of adhesions strained by the pneumoperitoneum using magnified laparoscopic view
Complete adhesiolysis can be avoided when the adhesion does not affect the current operative procedure
Operation time was shorter and the adhesiolysis was easier for the patients previously treated with LLR than open LR
It requires smaller (than open) working space between adhesions (this fact allows for minimal adhesiolysis, and operation time and bleeding amount were similar in primary and repeat LLR, although those from open LR are longer and increased)
Future perspectives
Further evaluations of anatomical resection or resections exposing major vessels after previous anatomical resection are needed
One of the possible advantages for minor repeat LR of CLD liver is that the deterioration of liver function can be minimized
It could prolong the overall survival of the HCC patients with CLD as a powerful local therapy which can be applied repeatedly with minimal deterioration of liver function

LLR: Laparoscopic liver resection; LR: Liver resection; HCC: Hepatocellular carcinoma; CLD: Chronic liver disease.